Barriers to physical activity among adults in primary healthcare units in the National Health System
a cross-sectional study in Brazil
Palavras-chave:
Motor activity, Exercise, Counseling, Primary health care, Public health, Epidemiologic studiesResumo
BACKGROUND: Many factors may negatively impact physical activity (PA), but studies lack evidence of individual predictors of perceived barriers to PA among adults in primary healthcare units. OBJECTIVE: To analyze associations between sociodemographic characteristics, health conditions, leisure-time physical activity (LTPA), PA counseling and perceived barriers to LTPA among adult patients in primary healthcare units of the National Health System in Brazil. DESIGN AND SETTING: Cross-sectional study on a representative sample of adults in primary healthcare units in São José dos Pinhais, Paraná, Brazil. METHODS: This study was conducted in 2019, among 779 adults (70% women). Barriers to LTPA, socio-demographic characteristics (sex, age, marital status, skin color, education and income), health conditions (body mass index, hypertension, diabetes, dyslipidemia, coronary disease and medications), LTPA level and PA counseling received were measured using validated, standardized procedures. The data were analyzed using chi-square and Mann-Whitney U tests. RESULTS: The most prevalent barriers were “feeling too tired” (53%) and “lack of time” (52%). PA counseling was inversely associated with “lack of time” (45% versus 57%; P < 0.001) but positively associated with “injury or disease” (38% versus 29%; P = 0.008). There was an inverse linear trend between the number of barriers and LTPA (walking and total) (P < 0.001). Most barriers differed in comparisons of sociodemographic characteristics, health conditions, LTPA and counseling (P < 0.05). CONCLUSIONS: The barriers vary according to the individual predictors. Counseling strategies need to be specific for each barrier and may be promising for promoting LTPA within primary healthcare.
Downloads
Referências
Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet Glob Health. 2018;6(10):e1077-e1086. PMID: 30193830; https://doi.org.10.1016/S2214-109X(18)30357-7
Ding D, Lawson KD, Kolbe-Alexander TL, et al. The economic burden of physical inactivity: a global analysis of major non-communicable diseases. Lancet. 2016;388(10051):1311-24. PMID: 27475266; https://doi.org/10.1016/S0140-6736(16)30383-X
Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Secretaria de Atenção à Saúde. Política Nacional de Promoção da Saúde: PNPS: anexo I da Portaria de Consolidação n° 2, de 28 de setembro de 2017, que consolida as normas sobre as políticas nacionais de saúde do SUS/Ministério da Saúde, Secretaria de Vigilância em Saúde, Secretaria de Atenção à Saúde. - Brasília: Ministério da Saúde, 218. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_promocao_saude.pdf Accessed in 2021 (Dec 20).
Pucci GC, Rech CR, Fermino RC, Reis RS. Association between physical activity and quality of life in adults. Rev Saude Publica. 2012;46(1):166-79. PMID: 22249758; https://doi.org/10.1590/s0034-89102012000100021
Fancourt D, Aughterson H, Finn S, Walker E, Steptoe A. How leisure activities affect health: a narrative review and multilevel theoretical framework of mechanisms of action. Lancet Psychiatry. 2021;8(4):329-39. PMID: 33581775; https://doi.org/10.1016/S2215-0366(20)30384-9
Bauman AE, Reis RS, Sallis JF, et al. Correlates of physical activity: why are some people physically active and others not? Lancet. 2012;380(9838):258-71. https://doi.org/10.1016/S0140-6736(12)60735-1
Sallis JF, Bull F, Guthold R, et al. Progress in physical activity over the Olympic quadrennium. Lancet. 2016;388(10051):1325-36. PMID: 27475270; https://doi.org/10.1016/S0140-6736(16)30581-5
Ding D, Ramirez Varela A, Bauman AE, et al. Towards better evidence-informed global action: lessons learnt from the Lancet series and recent developments in physical activity and public health. Br J Sports Med. 2020;54(8):462-8. PMID: 31562122; https://doi.org/10.1136/bjsports-2019-101001
Rech CR, Camargo EM, Araujo PAB, Loch MR, Reis RS. Perceived barriers to leisure-time physical activity in the Brazilian population. Rev Bras Med Esporte. 2018;24(4):303-9. https://doi.org/10.1590/1517-869220182404175052
Kienteka M, Camargo EM, Fermino RC, Reis RS. Quantitative and qualitative aspects of barriers to bicycle use for adults from Curitiba, Brazil. Rev Bras Cineantropom e Desempenho Hum. 2018;20(1):29-42. https://doi.org/10.5007/1980-0037.2018v20n1p29
Gagliardi AR, Abdallah F, Faulkner G, Ciliska D, Hicks A. Factors contributing to the effectiveness of physical activity counselling in primary care: a realist systematic review. Patient Educ Couns. 2015;98(4):412-9. PMID: 25499578; https://doi.org/10.1016/j.pec.2014.11.020 Erratum in Patient Educ Couns. 2015;98(7):923.
Orrow G, Kinmonth AL, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012;344:e1389. PMID: 22451477; https://doi.org/10.1136/bmj.e1389
Moraes SQ, Souza JH, Araújo PAB, Rech CR. Prevalence of physical activity counseling in Primary Health Care: a systematic review. Rev Bras Ativ Fis Saúde. 2019;24:1-12. https://doi.org/10.12820/rbafs.24e0073
Flores TR, Gomes AP, Soares ALG, et al. Counseling by health professionals and healthy behaviors among the elderly: population-based study in Pelotas, South of Brazil, 2014. Epidemiol e Serv Saude. 2018;27(1):e201720112. PMID: 29451616; https://doi.org/10.5123/s1679-49742018000100012
Duro SMS, Tomasi E, Siqueira FV, et al. Adult physical activity counseling by health professionals in Brazil: a national urban population survey. J Phys Act Health. 2015;12(8):1177-83. PMID: 25393813; https://doi.org/10.1123/jpah.2013-0213
Ribeiro EHC, Garcia LMT, Salvador EP, et al. Assessment of the effectiveness of physical activity interventions in the Brazilian Unified Health System. Rev Saude Publica. 2017;51:56. PMID: 28678906; https://doi.org/10.1590/S1518-8787.2017051006654
Polo MCE, Tavares GH, Kanitz AC, et al. Effectiveness of exercise and health education interventions in Brazilian primary health care. Motriz Rev Educ Fis. 2020;26(3):1-9. https://doi.org/10.1590/S1980-6574202000030004
Gomes GAO, Papini CB, Nakamura PM, Teixeira IP, Kokubun E. Barriers for physical activity in Primary Health Care. Rev Bras Ciênc Esporte. 2019;41(3):263-270. https://doi.org/10.1016/j.rbce.2018.04.007
Silva CRM, Bezerra J, Soares FC, et al. Percepção de barreiras e facilitadores dos usuários para participação em programas de promoção da atividade física [Perception of barriers and facilitators for users to participate in physical activity programs]. Cad Saude Publica. 2020;36(4): e00081019. PMID: 32374809; https://doi.org/10.1590/0102-311X0008101
Häfele V, Siqueira F. Physical activity counseling and change of behavior in Basic Health Units. Rev Bras Ativ Fís Saúde. 2016;21(6):581-92. https://doi.org/10.12820/rbafs.v.21n6p581-592
Silva AT, Santos LP, Rodriguez-Añez CR, Fermino RC. Modelo lógico do “Programa Cidade Ativa, Cidade Saudável” de São José dos Pinhais, Paraná. Logic Model of “Cidade Ativa, Cidade Saudável Program” in São José dos Pinhais, Paraná. Rev Bras Ativ Fís Saúde. 2021;26: e0193. https://doi.org/10.12820/rbafs.26e0193
Santos LP, Silva AT, Rech CR, Fermino RC. Physical activity counseling among adults in Primary Health Care centers in Brazil. Int J Environ Res Public Health. 2021;18(10):5079. PMID: 34064953; https://doi.org/10.3390/ijerph18105079
Custódio IG, Lopes AAS, Kopp D, et al. Pattern of use of public open spaces and physical activity levels in São José dos Pinhais, Brazil. Rev Bras Cien Esporte. 2021;43(e011220). https://doi.org/10.1590/rbce.43.e011220
Martins MO, Petroski EL. Measurement of perceived barriers to physical activity: proposed research instrument Rev Bras Cineantropom e Desempenho Hum. 2000;2(1):58-65. Available from: https://www.researchgate.net/publication/26452412_Measurement_of_perceived_barriers_to_physical_activities_Proposed_research_instrument Accessed in 2021 (Dec 20).
Reichert FF, Barros AJD, Domingues MR, Hallal PC. The role of perceived personal barriers to engagement in leisure-time physical activity. Am J Public Health. 2007;97(3):515-9. PMID: 17267731; https://doi.org/10.2105/AJPH.2005.07014
Associação Brasileira de Empresas de Pesquisa. Critério de Classificação Econômica Brasil. 2019. Available from: https://www.abep.org/criterio-brasil Accessed in 2021 (Dec 20).
Brasil. Ministério da Saúde, Secretaria de Vigilância em Saúde. Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis. Vigitel Brasil 2020: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2020 / Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Análise em Saúde e Vigilância de Doenças não Transmissíveis. – Brasília: Ministério da Saúde, 2021. Available from: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/publicacoes-svs/vigitel/relatorio-vigitel-2020-original.pdf/view Accessed in 2021 (Dec 20).
Matsudo S, Araújo T, Matsudo V, et al. International Physical Activity Questionnaire (IPAQ): study of validity and reliability in Brazil. Rev Bras Ativ Fís Saúde. 2001;6(2):5-18. https://doi.org/10.12820/rbafs.v.6n2p5-18
Craig CL, Marshall AL, Sjöström M, et al. International Physical Activity Questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381-95. PMID: 12900694; https://doi.org/10.1249/01.MSS.0000078924.61453.FB
Bull FC, Al-Ansari SS, Biddle S, et. al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-62. PMID: 33239350; https://doi.org/10.1136/bjsports-2020-102955
Reis RS, Yan Y, Parra DC, Brownson RC. Assessing participation in community-based physical activity programs in Brazil. Med Sci Sports Exerc. 2014;46(1):92-8. PMID: 23846162; https://doi.org/10.1249/MSS.0b013e3182a365ae
Ferreira RW, Caputo EL, Häfele CA, et al. Acesso aos programas públicos de atividade física no Brasil: Pesquisa Nacional de Saúde, 2013 [Access to public physical activity programs in Brazil: National Health Survey], 2013. Cad Saude Publica. 2019;35(2):e00008618. PMID: 30785483; https://doi.org/10.1590/0102-311x00008618
Siqueira FV, Nahas MV, Facchini LA, et al. Aconselhamento para a prática de atividade física como estratégica de educação à saúde [Counseling for physical activity as a health education strategy]. Cad Saude Publica. 2009;25(1):203-13. PMID: 19180303; https://doi.org/10.1590/s0102-311x2009000100022
Titze S, Schebesch-Ruf W, Lackinger C, et al. Short-and long-term effectiveness of a physical activity intervention with coordinated action between the health care sector and local sports clubs. a pragmatic trial in Austrian adults. Int J Environ Res Public Health. 2019;16(13):1-11. PMID: 31277331; https://doi.org/10.3390/ijerph16132362
Milton K, Cavill N, Chalkley A, et al. Eight investments that work for physical activity. J Phys Act Health. 2021;18(6):625-30. PMID: 33984836; https://doi.org/10.1123/jpah.2021-0112
Hallal PC, Umpierre D. Physical activity guidelines for the Brazilian population. Rev Bras Ativ Fis Saude. 2021;26(1):1-2. https://doi.org/10.12820/rbafs.26e0211
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
