Search tips
Search criteria

Results 1-25 (25)

Clipboard (0)

Select a Filter Below

more »
Year of Publication
1.  One-day workshop-based training improves physical activity prescription knowledge in Latin American physicians: a pre-test post-test study 
BMC Public Health  2016;16:1224.
The physical inactivity pandemic and related non-communicable diseases have made it imperative for medical doctors (MDs) to effectively provide lifestyle counseling as part of prevention and treatment plans for patients. A one-day certification workshop was designed to improve MDs PA prescription knowledge, as part of the Exercise is Medicine® (EIM®) global health initiative. The objective was to determine knowledge gain of MDs participating in a standardized, one-day PA prescription workshop performed throughout Latin America (LA).
A 20-question multiple-choice test on PA topics, based on international guidelines, was completed before and after the workshop. Pre and post-test analyses, without a control group, were performed on 1044 MDs after the 8-h workshop that was delivered 41 times across 12 LA countries, from January 2014 to January 2015. Knowledge improvement was determined using the class-average normalized gain and individual relative gain. T-tests with 95% confidence interval levels were conducted to analyze differences between MD specialties.
Test scores improved on average from 67 to 82% after the workshop (p <0.001). The average total individual relative gain was 29% [CI: 26 to 32%]. Relative gain by country ranged from 9.3% [CI: 2 to 16%; Nicaragua] to 73% [CI: 47 to 98%; Dominican Republic]. The mean of the 41 workshops’ class-average normalized gain was 46% [CI: 42 to 51%]. The largest groups of participants were general practitioners (GPs) (33%; n = 348), internal medicine (19%; n = 194), and family medicine (9%n = 92) specialists. Relative gain for GPs was not different than for all grouped primary care specialties (30% vs. 27%, p =0.48). The knowledge gain was higher for the workshop modules on screening/risk stratification and prescription (43% [CI: 39–48%] and 38% [CI: 34–42%], than for the module on PA benefits and risks (26% [CI: 23–28%]).
This one-day workshop had a positive impact on the knowledge gain of MD’s on the topic of PA prescription. Although all groups of specialties increased knowledge, GPs and family medicine MDs benefited the most. This short course is an effective continuing education strategy for teaching PA assessment, counseling and prescription to MDs in Latin America, a topic rarely included in the training of MD’s in the region and the world. Further follow-up is needed to ascertain impact on PA counseling practices.
Electronic supplementary material
The online version of this article (doi:10.1186/s12889-016-3883-2) contains supplementary material, which is available to authorized users.
PMCID: PMC5139105  PMID: 27919245
Exercise; Health behavior; Counseling; Continued Education; Lifestyle Medicine
2.  Health promoting practices and personal lifestyle behaviors of Brazilian health professionals 
BMC Public Health  2016;16:1114.
This study was conducted to examine the lifestyle behaviors and health promoting practices of physicians, nurses, and community health workers in Brazil.
A random sample of primary health care units in Brazil was selected, and a pretested questionnaire was administered via phone interviews, in 2011, to 182 physicians, 347 nurses, and 269 community health workers, totaling 798 health professionals. The total initial sample included 1600 eligible health professionals. Variables measured included physical activity, alcohol intake, hours of sleep, diet, and perceived self-efficacy to provide preventive counseling on related lifestyle behaviors.
More than 25 % of physicians, nurses, and community health workers reported eating 0–2 portions of fruits and vegetables per day. In terms of cervical and breast cancer, nurses reported to be ‘very prepared’ to advise patients on these topics more frequently than physicians. The prevalence of smoking ranged from 4.9 % among nurses to 7.4 % among community health workers. The proportion of physical inactivity ranged from 40.3 % among nurses to 52.1 % among community health workers.
A reasonably high proportion of physicians, nurses, and community health workers report not engaging in healthy lifestyle behaviors that impact chronic diseases, thus, they may be less likely to encourage such behaviors in their patients.
Electronic supplementary material
The online version of this article (doi:10.1186/s12889-016-3778-2) contains supplementary material, which is available to authorized users.
PMCID: PMC5078940  PMID: 27776496
Health promotion; Lifestyle behavior; Counseling; Health care; Brazil
3.  High muscular fitness has a powerful protective cardiometabolic effect in adults: influence of weight status 
BMC Public Health  2016;16:1012.
Low levels of muscular fitness (MF) are recognized as an important marker of nutritional status and a predictor of metabolic complications, cardiovascular disease and death, however, the relationship between MF, body mass index (BMI) and the subsequent cardiometabolic protective effects has been less studied among Latin American populations. This study identified an association between MF and the cardiometabolic risk score index (CMRSI) and the lipid-metabolic cardiovascular risk index (LMCRI) in a wide sample of university students grouped according to their BMI.
Six thousand ninety five healthy males (29.6 ± 11.7 year-old) participated in the study. Absolute strength was measured using a T.K.K. analogue dynamometer (handgrip), and the participant’s strength was then calculated relative to their body mass (MF/BM). The LMCRI was derived from the levels of triglycerides, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and glucose levels in a blood sample. The CMRSI was calculated by summing the standardized residuals (z-score) for waist circumference, total cholesterol, LDL-c, triglycerides, HDL-c, and median blood pressure. Subjects were divided into six subgroups according to BMI (normal vs. overweight/obese) and MF/BM tertiles (unfit, average, fit).
The group of participants with low and moderate levels of MF/BM showed higher CMRSI values independent of BMI (P < 0.001). The group with normal BMI and high MF/BM had the highest levels of cardiometabolic protection. All overweight/obese BMI groups had significantly higher LMCRI values independent of the level of MF/BM (P < 0.001).
Participants with high MF/BM showed reduced cardiometabolic risk, which increased significantly when they were within normal parameters.
PMCID: PMC5035511  PMID: 27663845
Muscle strength; Cardiovascular diseases; Cholesterol; Cardiometabolic risk; Exercise
4.  Associations between noncommunicable disease risk factors, race, education, and health insurance status among women of reproductive age in Brazil — 2011☆☆☆ 
Preventive Medicine Reports  2016;3:333-337.
Noncommunicable disease (NCD) risk factors increase the risk of adverse reproductive health outcomes and are becoming increasingly common in Brazil.
We analyzed VIGITEL 2011 telephone survey data for 13,745 Brazilian women aged 18–44 years in a probabilistic sample from 26 Brazilian state capitals and the Federal District. We examined associations between NCD risk factors (fruit and vegetable intake, leisure time physical activity, alcohol consumption, smoking status, BMI and hypertension status) and race, education, and insurance using chi-square tests and multivariable logistic regression models, estimating the average marginal effects to produce adjusted relative risk ratios (aRRs). Analyses were conducted using SAS 9.3 survey procedures and weighted to reflect population estimates.
Women with less than a college education were more likely to report physical inactivity (adjusted relative risk (aRR) and 95% confidence interval = 1.1 (1.1–1.2)), smoking (aRR = 1.7 (1.3–2.2)), and self-reported diagnoses of hypertension (aRR = 2.0 (1.6–2.5)) compared to women with a college education or greater. Similarly, women without health insurance were more likely to report physical inactivity (aRR = 1.1 (1.1–1.2)), smoking (aRR = 1.4 (1.1–1.8)), and self-reported diagnoses of hypertension aRR = 1.4 (1.1–1.7)) compared to women with health insurance. Less variation was found by race and NCD risk factors.
Targeted public health strategies and policies are needed to increase healthcare access and decrease educational and racial disparities in NCD risk factors among women of reproductive age in Brazil.
•Examine prevalence of NCD risk factors with race, education, and insurance status•We analyzed data from a probabilistic sample of 13,745 non-pregnant Brazilian women.•Less educated women reported more physical inactivity, smoking, and hypertension.•Uninsured women reported more physical inactivity, smoking and hypertension.•Less variation was found by race and noncommunicable disease risk factors.
PMCID: PMC4929178  PMID: 27419033
Women; Reproductive health; Education; Insurance; Health; Risk factors; Chronic disease
5.  Ferritin Levels in Colombian Children: Findings from the 2010 National Nutrition Survey (ENSIN) 
Low ferritin is associated with many adverse health outcomes and is highly prevalent worldwide. The aim of this study was to describe the key findings related to plasma ferritin levels to identify the prevalence and associated sociodemographic factors in a representative sample of children in Colombia, based on the 2010 National Nutrition Survey. We analyzed cross-sectional data from 6650 Colombian children between the ages of 5 and 12. Plasma ferritin levels were determined by chemiluminescence. Sociodemographic data was assessed by computer-assisted personal interview technology. All analyses were conducted considering the complex nature of the sample. Of the children assessed, 3.5% had low ferritin, defined as levels <12 µg/L. A multivariate logistic regression analysis revealed increased risks for low ferritin levels among black or Afro-Colombian ethnic group and for those living in the northern, western and southern regions of the country. In conclusion, a significant prevalence of anemia caused by low ferritin levels was found and various sociodemographic factors were associated with this finding in Colombia. Continued surveillance and implementation of interventions to improve dietary patterns among the identified high-risk groups should be considered. Implementing these recommendations can help reduce manifestations of iron deficiency (e.g., delays in infant and child development) and thus improve public health.
PMCID: PMC4847067  PMID: 27058547
nutrition; children; ferritin; prevalence
6.  Obesity Control in Latin American and U.S. Latinos 
Latinos are the largest and fastest-growing ethnically diverse group in the U.S.; they are also the most overweight. Mexico is now second to the U.S. in experiencing the worst epidemic of obesity in the world. Objectives of this study were to (1) conduct a systematic review of obesity-related interventions targeting Latinos living in the U.S. and Latin America and (2) develop evidence-based recommendations to inform culturally relevant strategies targeting obesity.
Evidence acquisition
Obesity-related interventions, published between 1965 and 2010, were identified through searches of major electronic databases in 2010–2011. Selection criteria included evaluation of obesity-related measures; intervention conducted in a community setting; and at least 50.0% Latino/Latin American participants, or with stratified results by race/ethnicity.
Evidence synthesis
Body of evidence was based on the number of available studies, study design, execution, and effect size. Of 19,758 articles, 105 interventions met final inclusion criteria. Interventions promoting physical activity and/or healthy eating had strong or sufficient evidence for recommending (1) school-based interventions in the U.S. and Latin America; (2) interventions for overweight or obese children in the healthcare context in Latin America; (3) individual-based interventions for overweight or obese adults in the U.S.; (4) individual-based interventions for adults in Latin America; and (5) healthcare-based interventions for overweight or obese adults in Latin America.
Most intervention approaches combined physical activity and healthy eating to address both sides of the energy-balance equation. Results can help guide comprehensive evidence-based efforts to tackle the obesity epidemic in the U.S. and Latin America.
PMCID: PMC4808744  PMID: 23597819
7.  Vitamin B12 concentrations in pregnant Colombian women: analysis of nationwide data 2010 
Vitamin B12 deficiency is associated with many adverse health outcomes and is highly prevalent worldwide. The present study assesses the prevalence and socio-demographic factors associated with vitamin B12 deficiency in a representative sample of pregnant women in Colombia.
We used data from the cross-sectional, nationally representative survey (ENSIN, 2010). A total of 1.781, (13–49 years old) pregnant women were enrolled. Serum Vitamin B12 a concentration was determined by chemiluminescence and sociodemographic date was assessed by computer-assisted personal interview technology. Multivariate analyses using unordered multinomial logistic regression models were conducted in the main analysis.
Vitamin B12 concentrations ranged from 45 to 1000 pg/mL (mean 299.2 pg/mL, 95 % CI 290.6 to 303.7 pg/mL). A total of 18.6 % of pregnant women had vitamin B12 concentrations below 200 pg/mL and 41.3 % had concentrations between 200 and 300 pg/mL. Being of indigenous ethnicity, living in the east and living in a rural area showed the lowest mean values (273.2 pg/mL, 270.8 pg/mL and 290.1 pg/mL, respectively). The multivariate logistic regression shows that pregnant women belonging to the indigenous ethnic group OR 2.2, (95 % CI 1.1 to 4.3), living in the pacific region (west) OR 4.4, (95 % CI 2.8 to 6.9), or national territories (south) OR 2.3, (95 % CI 1.4 to 3.7) were associated with a higher probability of serum vitamin B12 deficiency.
The prevalence of vitamin B12 deficiency in Colombian pregnant women is substantial. Factors associated with depletion among pregnant women should be considered for future interventions in countries experiencing nutritional transition.
PMCID: PMC4736095  PMID: 26832149
Nutrition; Pregnancy; Vitamin B12; Deficiency; Prevalence
8.  Reliability of Health-Related Physical Fitness Tests among Colombian Children and Adolescents: The FUPRECOL Study 
PLoS ONE  2015;10(10):e0140875.
Substantial evidence indicates that youth physical fitness levels are an important marker of lifestyle and cardio-metabolic health profiles and predict future risk of chronic diseases. The reliability physical fitness tests have not been explored in Latino-American youth population. This study’s aim was to examine the reliability of health-related physical fitness tests that were used in the Colombian health promotion “Fuprecol study”. Participants were 229 Colombian youth (boys n = 124 and girls n = 105) aged 9 to 17.9 years old. Five components of health-related physical fitness were measured: 1) morphological component: height, weight, body mass index (BMI), waist circumference, triceps skinfold, subscapular skinfold, and body fat (%) via impedance; 2) musculoskeletal component: handgrip and standing long jump test; 3) motor component: speed/agility test (4x10 m shuttle run); 4) flexibility component (hamstring and lumbar extensibility, sit-and-reach test); 5) cardiorespiratory component: 20-meter shuttle-run test (SRT) to estimate maximal oxygen consumption. The tests were performed two times, 1 week apart on the same day of the week, except for the SRT which was performed only once. Intra-observer technical errors of measurement (TEMs) and inter-rater (reliability) were assessed in the morphological component. Reliability for the Musculoskeletal, motor and cardiorespiratory fitness components was examined using Bland–Altman tests. For the morphological component, TEMs were small and reliability was greater than 95% of all cases. For the musculoskeletal, motor, flexibility and cardiorespiratory components, we found adequate reliability patterns in terms of systematic errors (bias) and random error (95% limits of agreement). When the fitness assessments were performed twice, the systematic error was nearly 0 for all tests, except for the sit and reach (mean difference: -1.03% [95% CI = -4.35% to -2.28%]. The results from this study indicate that the “Fuprecol study” health-related physical fitness battery, administered by physical education teachers, was reliable for measuring health-related components of fitness in children and adolescents aged 9–17.9 years old in a school setting in Colombia.
PMCID: PMC4608730  PMID: 26474474
9.  The Evidence in Support of Physicians and Health Care Providers as Physical Activity Role Models 
American journal of lifestyle medicine  2014;1.55982761352012E15:doi:10.1177/155982761352012.
Physical inactivity constitutes the fourth leading cause of death worldwide. Health care providers (HCPs) should play a key role in counseling and appropriately referring their patients to adopt physical activity (PA). Previous reports suggest that active HCPs are more likely to provide better, more credible, and motivating preventive counseling to their patients. This review summarizes the available evidence on the association between HCPs’ personal PA habits and their related PA counseling practices. Based on relevant studies, a snowball search strategy identified, out of 196 studies screened, a total of 47 pertinent articles published between 1979 and 2012. Of those, 23 described HCPs’ PA habits and/or their counseling practices and 24 analytic studies evaluated the association between HCPs’ personal PA habits and their PA counseling practices. The majority of studies came from the United States (n = 33), and 9 studies included nonphysicians (nurses, pharmacists, and other HCPs). PA levels were mostly self-reported, and counseling was typically assessed as self-reported frequency or perceived self-efficacy in clinical practice. Most (19 out of 24) analytic studies reported a significant positive association between HCPs’ PA habits and counseling frequency, with odds ratios ranging between 1.4 and 5.7 (P < .05), in 6 studies allowing direct comparison. This review found consistent evidence supporting the notion that physically active physicians and other HCPs are more likely to provide PA counseling to their patients and can indeed become powerful PA role models. This evidence appears sufficient to justify randomized trials to determine if adding interventions to promote PA among HCPs, also results in improvements in the frequency and quality of PA preventive counseling and referrals, delivered by HCPs, to patients in primary care settings. Future studies should also aim at objectively quantifying the effect of HCPs’ PA role-modeling and how it influences patients’ PA levels. More evidence from low-to-middle income countries is needed, where 80% of the deaths due to inactivity and related noncommunicable diseases already occur.
PMCID: PMC4511730  PMID: 26213523
health care personnel; physical activity; lifestyle medicine; counseling
10.  Physicians', nurses' and community health workers' knowledge about physical activity in Brazil: A cross-sectional study☆ 
Preventive Medicine Reports  2015;2:467-472.
To measure knowledge of current recommendations of physical activity and consequences of physical inactivity among healthcare providers throughout Brazil.
A phone survey of 1600 randomly selected primary healthcare units in Brazil was conducted between January and July 2011. At each unit, a physician, nurse or community healthcare worker (n = 798) responded to a 40-minute survey, eliciting information about demographics, knowledge, and health behaviors pertaining to physical activity.
Among nurses and community healthcare workers, > 95% reported needing more information on physical activity guidelines. Among physicians this proportion was 80%. Nearly 40% of the professionals incorrectly believed 90-min of moderate-intensity physical activity per week is the recommended amount for health benefits; nearly 30% believed that 90-min of vigorous-intensity activity per week is needed for the same purpose. More than 75% of all groups reported that type II diabetes, hypertension, depression, and coronary heart disease might result from physical inactivity, but on average only 60% from each group are aware of osteoporosis as a possible consequence of physical inactivity.
Training health professionals in how to convey all relevant information about physical activity to their patients is critical for health promotion within the primary care system in Brazil.
•Nurses and physicians reported more knowledge on physical activity recommendations compared to community health workers.•Physicians were more likely to recommend physical activity when a health problem was identified.•Physicians are limited by appointment times in their ability to counsel patients.
PMCID: PMC4721435  PMID: 26844104
Physical activity; Brazil; Primary health care; Counseling; Knowledge
11.  Association of knowledge, preventive counseling and personal health behaviors on physical activity and consumption of fruits or vegetables in community health workers 
BMC Public Health  2015;15:344.
There is evidence that if a health professional is active and has a healthy diet, he/she is more likely to advise patients about the benefits of physical activity and healthy eating The aims of this study were to: (1) describe the personal physical activity, consumption of fruits and vegetables behaviors and nutritional status of community health workers; (2) evaluate the association between knowledge, delivery of preventive counseling and personal behaviors among community health workers.
This was a cross-sectional study conducted in a nationally sample of health professionals working in primary health care settings in Brazil in 2011. This survey was part of the second phase of the Guide for Useful Interventions for Activity in Brazil and Latin America project, and data were collected through telephone interviews of 269 community health workers from the Unified Health Care system of Brazil. We applied questionnaires about personal reported behaviors, knowledge and preventive counseling in physical activity and consumption of fruits and vegetables. We calculated the prevalence and associations between the variables with logistic regression.
The proportion of community health workers that practiced 150 minutes per week of physical activity in leisure time or transportation was high (64.9%). Half of community health workers were overweight and only 26.2% reported consuming five portions/day of fruits or vegetables. Most community health workers reported counseling about physical activity for more than six months (59.7%), and most were not knowledgeable of the fruits and vegetables and physical activity recommendations. Meeting the fruits and vegetables recommendations was associated with correct knowledge (OR = 4.5; CI95% 1.03;19.7), with reporting 150 minutes or more of physical activity per week (OR = 2.0; CI95% 1.03;3.7) and with reporting physical activity in leisure time (OR = 2.0; CI95% 1.05;3.6). Regular physical activity counseling was associated with reporting 10–149 minutes per week (OR = 3.8; CI95% 1.1;13.3) and with more than 150 minutes of physical activity per week (OR = 4.9; CI95% 1.5;16.5).
Actions to promote physical activity and healthy eating and to improve knowledge among community health workers within the health care system of Brazil could have a potential positive influence on delivery of preventive counseling to patients on this topic.
PMCID: PMC4410462  PMID: 25885709
Physical activity; Consumption of fruits and vegetables; Community health workers; Primary health care settings; Knowledge; Preventive counseling; Personal behavior
12.  Prevalence of health promotion programs in primary health care units in Brazil 
Revista de Saúde Pública  2014;48(5):837-844.
Assessment of prevalence of health promotion programs in primary health care units within Brazil’s health system.
We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units.
Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did.
Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil.
PMCID: PMC4211580  PMID: 25372175
Health Programs and Plans; Health Centers; Health Promotion; Primary Health Care; Health Surveys
13.  Geographical Variation in Health-Related Physical Fitness and Body Composition among Chilean 8th Graders: A Nationally Representative Cross-Sectional Study 
PLoS ONE  2014;9(9):e108053.
In addition to excess adiposity, low cardiorespiratory fitness (CRF) and low musculoskeletal fitness (MSF) are important independent risk factors for future cardio-metabolic disease in adolescents, yet global fitness surveillance in adolescents is poor. The objective of this study was to describe and investigate geographical variation in levels of health-related physical fitness, including CRF, MSF, body mass index (BMI), and waist circumference (WC) in Chilean 8th graders.
This cross-sectional study was based on a population-based, representative sample of 19,929 8th graders (median age = 14 years) in the 2011 National Physical Education Survey from Chile. CRF was assessed with the 20-meter shuttle run test, MSF with standing broad jump, and body composition with BMI and WC. Data were classified according to health-related standards. Prevalence of levels of health-related physical fitness was mapped for each of the four variables, and geographical variation was explored at the country level by region and in the Santiago Metropolitan Area by municipality.
Girls had significantly higher prevalence of unhealthy CRF, MSF, and BMI than boys (p<0.05). Overall, 26% of boys and 55% of girls had unhealthy CRF, 29% of boys and 35% of girls had unhealthy MSF, 29% of boys and 44% of girls had unhealthy BMI, and 31% of adolescents had unhealthy WC. High prevalence of unhealthy fitness levels concentrates in the northern and middle regions of the country and in the North and Southwest sectors for the Santiago Metropolitan Area.
Prevalence of unhealthy CRF, MSF, and BMI is relatively high among Chilean 8th graders, especially in girls, when compared with global estimates. Identification of geographical regions and municipalities with high prevalence of unhealthy physical fitness presents opportunity for targeted intervention.
PMCID: PMC4177890  PMID: 25255442
15.  Exercise-referral scheme to promote physical activity among hypertensive patients: design of a cluster randomized trial in the Primary Health Care Units of Mexico’s Social Security System 
BMC Public Health  2014;14:706.
Although the benefits of physical activity (PA) on to prevent and manage non-communicable diseases are well known, strategies to help increase the levels of PA among different populations are limited. Exercise-referral schemes have emerged as one effective approach to promote PA; however, there is uncertainty about the feasibility and effectiveness of these schemes in settings outside high-income countries. This study will examine the effectiveness of a scheme to refer hypertensive patients identified in Primary Health Care facilities (PHCU) of the Mexican social security institution to a group PA program offered in the same institution.
Methods and design
We will describe the methods of a cluster randomized trial study designed to evaluate the effectiveness of an exercise referral scheme to increasing physical activity in hypertensive patients compared to a non-referral scheme. Four PHCU were selected for the study; the PHCU will take part as the unit of randomization and sedentary hypertensive patients as the unit of assessment. 2 PHCU of control group (GC) will provide information to hypertensive patients about physical activity benefits and ways to increase it safely. 2 PHCU of intervention group (IG) will refer patients to sports facilities at the same institution, to follow a group-based PA program developed to increase the PA levels with a designed based on the Transtheoretical Model and Social Cognitive Theory. To evaluate the effects of the intervention as well as short-term maintenance of the intervention’s effects, PA will be assessed at baseline, at 24 and 32 weeks of follow-up.
The main outcome will be the difference before and after intervention in the percentage of participants meeting recommended levels of PA between and within intervention and control groups. PA will be measured through self-report and with objective measure by accelerometer.
This study will allow us to evaluate a multidisciplinary effort to link the primary care and community-based areas of the same health care system. Our findings will provide important information about the feasibility and effectiveness of an exercise-referral scheme and will be useful for decision-making about the implementation of strategies for increasing PA among hypertensive and other clinical populations in Mexico and Latin America.
Trial registration Identifier: NCT01910935. Date of registration: 07/05/2013.
PMCID: PMC4227118  PMID: 25011612
Exercise-referral; Physical activity; Hypertension; Mexico
16.  Muscular strength and adiposity as predictors of adulthood cancer mortality in men 
We examined the associations between muscular strength, markers of overall and central adiposity and cancer mortality in men.
Prospective cohort study including 8,677 men aged 20-82 years followed from 1980 to 2003. Participants were enrolled in The Aerobics Centre Longitudinal Study, the Cooper Clinic in Dallas, Texas, U.S. Muscular strength was quantified by combining 1-repetition maximal measures for leg and bench presses. Adiposity was assessed by body mass index (BMI), percent body fat, and waist circumference.
Cancer death rates per 10,000 person-years adjusted for age and examination year were: 17.5, 11.0, and 10.3 across incremental thirds of muscular strength (P=0.001); 10.9, 13.4, and 20.1 across BMI groups of 18.5-24.9, 25.0-29.9, and ≥30kg/m2, respectively (P=0.008); 11.6 and 17.5 for normal (<25%) and high percent body fat (≥25%), respectively (P=0.006); and 12.2 and 16.7 for normal (≤102 cm) and high waist circumference (>102 cm), respectively (P=0.06). After adjusting for additional potential confounders, hazard ratios (95% confidence intervals) were 1.00 (referent), 0.65 (0.47-0.90), and 0.61 (0.44-0.85) across incremental thirds of muscular strength, respectively (P=0.003 for linear trend). Further adjustment for BMI, percent body fat, waist circumference, or cardiorespiratory fitness had little effect on the association. The associations of BMI, percent body fat, or waist circumference with cancer mortality did not persist after further adjusting for muscular strength (all P≥0.1).
Higher levels of muscular strength are associated with lower cancer mortality risk in men, independent of clinically established measures of overall and central adiposity, and other potential confounders.
PMCID: PMC3762582  PMID: 19366909
Muscular strength; obesity; cancer; cardiorespiratory fitness; resistance exercise
17.  Physical activity counseling in primary health care in Brazil: a national study on prevalence and associated factors 
BMC Public Health  2013;13:794.
The aim of this study was to determine the prevalence and correlates of physical activity counseling among physicians and nurses working in primary health care in Brazil.
A phone survey was carried out in 2011 with professionals working in primary health care in Brazil. The target sample consisted of 1,600 randomly selected primary care units covering all regions of the country. We successfully interviewed 529 professionals within the sampled units; 182 physicians and 347 nurses. The overall response rate was 49.6%. Multivariable logistic regression was used to estimate correlates of counseling in the whole sample and separately for physicians and nurses.
The prevalence of regular physical activity counseling for at least six months was 68.9% (95% CI 64.9; 72.8) and was significantly higher among physicians compared to nurses (p < 0.05). Most professionals (93.2%) interviewed were unfamiliar with current physical activity recommendations for health. In the adjusted analysis, physical activity counseling was more frequent among those who report assessing patient’s physical activity (OR = 2.16; 95% CI 1.41; 3.29), those reporting that lack of time was not a barrier for counseling (OR = 0.62 95% CI 0.42-0.93), those who felt prepared to provide physical activity counseling (OR = 2.34; 95% CI 1.50-3.66), and those working at primary care units offering physical activity programs for patients (OR = 2.06; 95% CI 1.33-3.20). In the stratified analysis, only assessing patient’s physical activity was a significant correlate among physicians whereas assessing patient’s physical activity, feeling prepared to provide counseling and working in units with physical activity interventions were significant correlates among nurses.
Physicians and nurses deemed physical activity counseling of great importance in primary health care in Brazil. However, in order to increase the quality of counseling and the number of professionals engaging in this activity, these health teams require greater knowledge about physical activity (global recommendations for health) as well as training on the application of instruments for assessing physical activity. Moreover, sufficient time must be allowed during consultations for the counseling process, and physical activity promotion programs should be implemented within the primary health care units.
PMCID: PMC3844313  PMID: 24005006
Physical activity promotion; Physical activity counseling; Primary health care; Physicians; Nurses; Knowledge; Associated factors
18.  Impact of Physical Inactivity on the World’s Major Non-Communicable Diseases 
Lancet  2012;380(9838):219-229.
Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including the world’s major non-communicable diseases (NCDs) of coronary heart disease (CHD), type 2 diabetes, and breast and colon cancers, and shortens life expectancy. Because much of the world’s population is inactive, this presents a major public health problem. We aimed to quantify the impact of physical inactivity on these major NCDs by estimating how much disease could be averted if those inactive were to become active and to estimate gain in life expectancy, at the population level.
Using conservative assumptions, we calculated population attributable fractions (PAF) associated with physical inactivity for each of the major NCDs, by country, to estimate how much disease could be averted if physical inactivity were eliminated, and used life table analysis to estimate gains in life expectancy of the population.
Worldwide, we estimate that physical inactivity is responsible for 6% of the burden of disease from CHD (range: 3.2% in South-east Asia to 7.8% in the Eastern Mediterranean region); 7% of type 2 diabetes (3.9% to 9.6%), 10% of breast cancer (5.6% to 14.1%), and 10% of colon cancer (5.7% to 13.8%). Inactivity is responsible for 9% of premature mortality (5.1% to 12.5%), or >5.3 of the 57 million deaths that occurred worldwide in 2008. If inactivity were not eliminated, but decreased instead by 10% or 25%, >533,000 and >1.3 million deaths, respectively, may be averted each year. By eliminating physical inactivity, life expectancy of the world’s population is estimated to increase by 0.68 (0.41 to 0.95) years.
Physical inactivity has a major health impact on the world. Elimination of physical inactivity would remove between 6% and 10% of the major NCDs of CHD, type 2 diabetes, and breast and colon cancers, and increase life expectancy.
PMCID: PMC3645500  PMID: 22818936
19.  Cardiorespiratory Fitness and Proximity to Commercial Physical Activity Facilities Among 12th Grade Girls 
The Journal of Adolescent Health  2012;50(5):497-502.
To investigate the relationship between proximity to commercial physical activity facilities and cardiorespiratory fitness of 12th grade girls.
Adolescent girls (N=786, 60% African American, mean age=17.6 ± 0.6 years) performed a submaximal fitness test (PWC170). Commercial physical activity facilities were mapped and counted within a 0.75-mile street-network buffer around girls’ homes using Geographic Information Systems (GIS). Sedentary activities and vigorous physical activity (VPA, greater or equal to 6 METs) were determined by the average number of 30-minute blocks reported per day on the 3-Day Physical Activity Recall (3DPAR). Mixed model regressions were calculated using school as a random variable.
Girls had higher weight-relative PWC170 scores if there was a commercial physical activity facility (n=186, 12.4±4.2 kg·m/min/kg) within 0.75-mile street-network buffer of home as compared to girls without a nearby facility (n=600, 11.2±3.6 kg·m/min/kg). After adjusting for demographic variables, sports participation, sedentary behaviors and VPA, having one or more commercial physical activity facilities within a 0.75-mile street-network buffer of homes was significantly related to cardiorespiratory fitness.
Both with and without adjustment for covariates, the presence of a commercial physical activity facility within a 0.75-mile street-network buffer of a girl’s home was associated with higher cardiorespiratory fitness.
PMCID: PMC3336089  PMID: 22525114
20.  The association between Colombian medical students' healthy personal habits and a positive attitude toward preventive counseling: cross-sectional analyses 
BMC Public Health  2009;9:218.
Physician-delivered preventive counseling is important for the prevention and management of chronic diseases. Data from the U.S. indicates that medical students with healthy personal habits have a better attitude towards preventive counseling. However, this association and its correlates have not been addressed in rapidly urbanized settings where chronic disease prevention strategies constitute a top public health priority. This study examines the association between personal health practices and attitudes toward preventive counseling among first and fifth-year students from 8 medical schools in Bogotá, Colombia.
During 2006, a total of 661 first- and fifth-year medical students completed a culturally adapted Spanish version of the "Healthy Doctor = Healthy Patient" survey (response rate = 78%). Logistic regression analyses were used to assess the association between overall personal practices on physical activity, nutrition, weight control, smoking, alcohol use (main exposure variable) and student attitudes toward preventive counseling on these issues (main outcome variable), stratified by year of training and adjusting by gender and medical training-related factors (basic knowledge, perceived adequacy of training and perception of the school's promotion on each healthy habit).
The median age and percentage of females for the first- and fifth-year students were 21 years and 59.5% and 25 years and 65%, respectively. After controlling for gender and medical training-related factors, consumption of ≥ 5 daily servings of fruits and/or vegetables, not being a smoker or binge drinker were associated with a positive attitude toward counseling on nutrition (OR = 4.71; CI = 1.6–14.1; p = 0.006 smoking (OR = 2.62; CI = 1.1–5.9; p = 0.022), and alcohol consumption (OR = 2.61; CI = 1.3–5.4; p = 0.009), respectively.
As for U.S. physician and medical students, a positive association was found between the personal health habits of Colombian medical students and their corresponding attitudes toward preventive counseling, independent of gender and medial training-related factors. Our findings, the first relating to this association in medical students in developing regions, also suggest that within the medical school context, interventions focused on promoting healthy student lifestyles can potentially improve future physician's attitudes toward preventive counseling.
PMCID: PMC2721845  PMID: 19575806
21.  Uric Acid and the Development of Metabolic Syndrome in Women and Men 
Associations between serum uric acid (UA) levels and metabolic syndrome (MetS) have been reported in cross-sectional studies. Limited information, however, is available concerning the prospective association of UA and risk of developing MetS. The authors evaluated UA as a risk factor for incident MetS in a prospective study of 8,429 men and 1,260 women (ages 20–82 years) who were free of MetS and for whom measures of waist girth, resting blood pressure, fasting lipids and glucose were taken during baseline and follow-up examinations between 1977 and 2003. Hyperuricemia was defined as >7.0 mg/dL in men and >6.0 mg/dL in women. MetS was defined with NCEP ATP III criteria. The overall prevalence of hyperuricemia was 17%. During a mean follow-up of 5.7 years, 1120 men and 44 women developed MetS. Men with serum UA concentrations ≥6.5 mg/dL (upper third) had a 1.60-fold increase in risk of MetS (95% confidence interval [CI]: 1.34–1.91), as compared with those who had concentrations <5.5 mg/dL (lowest third). Among women, the risk of MetS was at least 2-fold higher for serum UA concentrations ≥4.6 mg/dL (p for trend=0.02). Higher serum UA is a strong and independent predictor of incident MetS in men and women.
PMCID: PMC2486830  PMID: 18502269
22.  Physical Activity and Neighborhood Resources in High School Girls 
Physical activity behavior is influenced by a person's physical environment, but few studies have used objective measures to study the influences of the physical environment on physical activity behavior in youth. The purpose of this study was to examine the relationship between selected neighborhood physical activity resources and physical activity levels in high school girls.
Participants were students in schools that had participated in a large physical activity intervention trial. The 3-Day Physical Activity Recall was completed by 1506 12th-grade girls. Data on physical activity facilities and resources in the participating communities were collected using a variety of methods. Physical activity resources within a 0.75-mile street-network buffer around each girl's home were counted using ArcGIS, version 9.1. Mixed-model regression models were used to determine if there was a relationship between three physical activity variables and the number of physical activity resources within the 0.75-mile buffer. Data were collected in 2002–2003 and analyzed in 2006–2007.
On average, 3.5 physical activity resources (e.g., schools, parks, commercial facilities) were located within the 0.75-mile street-network buffer. Thirty-six percent of the girls had no physical activity resource within the buffer. When multiple physical activity resources were considered, the number of commercial physical activity facilities was significantly associated with reported vigorous physical activity, and the number of parks was associated with total METs in white girls.
Multiple physical activity resources within a 0.75-mile street-network buffer around adolescent girls' homes are associated physical activity in those girls. Several types of resources are associated with vigorous physical activity and total activity in adolescent girls. Future studies should examine the temporal and causal relationships between the physical environment, physical activity, and health outcomes related to physical activity.
PMCID: PMC2408745  PMID: 18407008
23.  Association between muscular strength and mortality in men: prospective cohort study 
BMJ : British Medical Journal  2008;337(7661):92-95.
Objective To examine prospectively the association between muscular strength and mortality from all causes, cardiovascular disease, and cancer in men.
Design Prospective cohort study.
Setting Aerobics centre longitudinal study.
Participants 8762 men aged 20-80.
Main outcome measures All cause mortality up to 31 December 2003; muscular strength, quantified by combining one repetition maximal measures for leg and bench presses and further categorised as age specific thirds of the combined strength variable; and cardiorespiratory fitness assessed by a maximal exercise test on a treadmill.
Results During an average follow-up of 18.9 years, 503 deaths occurred (145 cardiovascular disease, 199 cancer). Age adjusted death rates per 10 000 person years across incremental thirds of muscular strength were 38.9, 25.9, and 26.6 for all causes; 12.1, 7.6, and 6.6 for cardiovascular disease; and 6.1, 4.9, and 4.2 for cancer (all P<0.01 for linear trend). After adjusting for age, physical activity, smoking, alcohol intake, body mass index, baseline medical conditions, and family history of cardiovascular disease, hazard ratios across incremental thirds of muscular strength for all cause mortality were 1.0 (referent), 0.72 (95% confidence interval 0.58 to 0.90), and 0.77 (0.62 to 0.96); for death from cardiovascular disease were 1.0 (referent), 0.74 (0.50 to 1.10), and 0.71 (0.47 to 1.07); and for death from cancer were 1.0 (referent), 0.72 (0.51 to 1.00), and 0.68 (0.48 to 0.97). The pattern of the association between muscular strength and death from all causes and cancer persisted after further adjustment for cardiorespiratory fitness; however, the association between muscular strength and death from cardiovascular disease was attenuated after further adjustment for cardiorespiratory fitness.
Conclusion Muscular strength is inversely and independently associated with death from all causes and cancer in men, even after adjusting for cardiorespiratory fitness and other potential confounders.
PMCID: PMC2453303  PMID: 18595904
24.  Association between muscular strength and mortality in men: prospective cohort study 
Objective To examine prospectively the association between muscular strength and mortality from all causes, cardiovascular disease, and cancer in men.
Design Prospective cohort study.
Setting Aerobics centre longitudinal study.
Participants 8762 men aged 20-80.
Main outcome measures All cause mortality up to 31 December 2003; muscular strength, quantified by combining one repetition maximal measures for leg and bench presses and further categorised as age specific thirds of the combined strength variable; and cardiorespiratory fitness assessed by a maximal exercise test on a treadmill.
Results During an average follow-up of 18.9 years, 503 deaths occurred (145 cardiovascular disease, 199 cancer). Age adjusted death rates per 10 000 person years across incremental thirds of muscular strength were 38.9, 25.9, and 26.6 for all causes; 12.1, 7.6, and 6.6 for cardiovascular disease; and 6.1, 4.9, and 4.2 for cancer (all P<0.01 for linear trend). After adjusting for age, physical activity, smoking, alcohol intake, body mass index, baseline medical conditions, and family history of cardiovascular disease, hazard ratios across incremental thirds of muscular strength for all cause mortality were 1.0 (referent), 0.72 (95% confidence interval 0.58 to 0.90), and 0.77 (0.62 to 0.96); for death from cardiovascular disease were 1.0 (referent), 0.74 (0.50 to 1.10), and 0.71 (0.47 to 1.07); and for death from cancer were 1.0 (referent), 0.72 (0.51 to 1.00), and 0.68 (0.48 to 0.97). The pattern of the association between muscular strength and death from all causes and cancer persisted after further adjustment for cardiorespiratory fitness; however, the association between muscular strength and death from cardiovascular disease was attenuated after further adjustment for cardiorespiratory fitness.
Conclusion Muscular strength is inversely and independently associated with death from all causes and cancer in men, even after adjusting for cardiorespiratory fitness and other potential confounders.
PMCID: PMC2453303  PMID: 18595904
25.  Television viewing and its association with overweight in Colombian children: results from the 2005 National Nutrition Survey: A cross sectional study 
There has been an ongoing discussion about the relationship between time spent watching television and childhood obesity. This debate has special relevance in the Latin American region were the globalization process has increased the availability of screen-based entertainment at home. The aim of this study is to examine the association between television viewing and weight status in Colombian children.
This cross sectional investigation included children aged 5 to12 yrs from the National Nutrition Survey in Colombia (ENSIN 2005). Weight and height were measured in 11,137 children in order to calculate body mass index. Overweight was defined by international standards. Time spent viewing television was determined for these children through parental reports. Multiple logistic regression analyses were conducted for different subgroups and adjusted for potential confounders in order to study the association between television viewing and weight status in this population.
Among the surveyed children, 41.5% viewed television less than two hours/day; 36.8% between two and 3.9 hours/day and 21.7% four or more hours/day. The prevalence of overweight (obesity inclusive) in this population was 11.1%. Children who were classified as excessive television viewers (between two and 3.9 hours/day or 4 or more hours/day) were more likely to be overweight (OR: 1.44 95% CI: 1.41–1.47 and OR: 1.32 95% CI: 1.30–1.34, respectively) than children who reported to watch television less than 2 hours/day. Stratified analyses by age, gender and urbanization levels showed similar results.
Television viewing was positively associated with the presence of overweight in Colombian children. A positive association between urbanization level and television viewing was detected. Considering that the majority of Colombian children lives in densely populated cities and appear to engage in excessive television viewing these findings are of public health relevance for the prevention of childhood obesity.
PMCID: PMC2048503  PMID: 17880726

Results 1-25 (25)