O papel do aconselhamento médico para aumentar a adesão à atividade física na população
Palavras-chave:
Atividade física, Exercício, Medicina do comportamento, Promoção da saúde, Clínica geralResumo
A prática regular de atividade física em níveis adequados assegura diversos benefícios para o indivíduo a curto, médio e longo prazo, o que determina sua importância na promoção de saúde. Por outro lado, o sedentarismo tem atingido níveis alarmantes na população em geral qualifi cando-o como um problema grave da saúde em proporções endêmicas. O médico, assim como outros profi ssionais da saúde, deveriam estar atentos a este fato e promover a prática da atividade física durante a sua prática clínica. Entretanto, existem evidências sugerindo que o aconselhamento de atividade física tem sido realizado pelo médico, principalmente, para pacientes que apresentam co-morbidades sugerindo o seu uso como uma ferramenta terapêutica ao invés de preventivo. O objetivo desta revisão foi auxiliar os médicos a compreender os benefícios preventivos da atividade física, subsidiando-os sobre as teorias comportamentais e provendo-os com ferramentas para avaliar e aconselhar os pacientes adequadamente sobre os assuntos relacionados à atividade física. Além disto, compreendendo as barreiras enfrentadas pelos pacientes, esperamos sugerir metodologias que auxiliarão médicos a empregar a promoção da atividade física de maneira adequada. Esperamos, desta forma, auxiliar o médico a utilizar o aconselhamento como um instrumento para promover a saúde da população.
Downloads
Referências
Physical activity and cardiovascular health. NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. JAMA. 1996;276(3):241-6.
Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273(5):402-7.
Lee IM, Sesso HD, Oguma Y, Paffenbarger RS Jr. Relative intensity of physical activity and risk of coronary hearth disease. Circulation. 2003;107(8):1110-6.
Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: a meta-analysis. Stroke. 2003;34(10):2475-81.
Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136(7):493-503.
Hu G, Barengo, NC, Tuomilehto J, Lakka TA, Nissinen A, Jousilahti P. Relationship of physical activity and body mass index to the risk of hypertension: a prospective study in Finland. Hypertension. 2004;43(1):25-30.
Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
Duncan GE, Perri MG, Theriaque DW, Hutson AD, Eckel RH, Stacpoole PW. Exercise training, without weight loss, increases insulin sensitivity and postheparin plasma lipase activity in previ- ously sedentary adults. Diabetes Care. 2003;26(3):557-62.
Berman DM, Rogus EM, Busby-Whitehead MJ, Katzel LI, Goldberg AP. Predictors of adipose tissue lipoprotein lipase in middle-age and older men: relationship to leptin and obesity, but not cardiovascular fitness. Metabolism. 1999;48(2):183-9.
Carroll S, Dudfield M. What is the relationship between ex- ercise and metabolic abnormalities? A review of the metabolic syndrome. Sports Med. 2004;34(6):371-418.
Donnelly JE, Hill JO, Jacobsen DJ, et al. Effects of 16-month randomized controlled exercise trial on body weight and com- position in young, overweight men and women: the Midwest Exercise Trial. Arch Intern Med. 2003;163(11):1343-50.
Jakicic JM, Marcus BH, Gallagher KI, Napolitano M, Lang W. Effect of exercise duration and intensity on weight in overweight, sedentary women: a randomized trial. JAMA. 2003;290(10):1323-30.
Lee IM, Sesso HD, Paffenbarger RS Jr. Physical activity and risk of lung cancer. Int J Epidemiol. 1999;28(4):620-5.
Mao Y, Pan S, Wen SW, Johnson KC; Canadian Cancer Registries Epidemiology Research Group. Physical activity and the risk of lung cancer in Canada. Am J Epidemiol. 2003;158(6):564-75.
McTiernan A, Kooperberg C, White E, et al. Recreation physical activity and the risk of breast cancer in postmenopausal women: the Women’s Health Initiative Cohort Study. JAMA. 2003;290(10):1331-6.
Hou L, Ji B, Blair A, Dai Q, Gao YT, Chow WH. Commuting physical activity and risk of colon cancer in Shanghai, China. Am J Epidemiol. 2004;160(9):860-7.
Slattery ML. Physical activity and colorectal cancer. Sports Med. 2004;34(4):239-52.
Greist JH. Exercise intervention with depressed outpatients. In: Morgan WP, Goldston SE, editors. Exercise and mental health. Washington: Hemisphere; 1987. p. 117-21.
Strawbridge WJ, Deleger S, Roberts RE, Kaplan GA. Physical activity reduces the risk of subsequent depression for older adults. Am J Epidemiol. 2002;156(4):328-34.
Barnes DE, Yaffe K, Satariano WA, Tager IB. A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults. J Am Geriatr Soc. 2003;51(4):459-65.
U.S. Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. Atlanta: U.S. Depart- ment of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996. Available from URL: http://www.cdc.gov/nccdphp/sgr/sgr.htm. Accessed in 2007 (Feb 21).
Ainsworth BE, Macera CA. Physical inactivity. In: Brownson RC, Remington PL, Davis JR, editors. Chronic disease epide- miology and control. Washington: American Public Health Association; 1998. p. 191-213.
Clark DO. Physical activity and its correlates among urban primary care patients aged 55 years or older. J Gerontol B Psychol Sci Soc Sci. 1999;54(1):S41-8.
Rego RA, Berardo FA, Rodrigues SS, et al. Fatores de risco para doenças crônicas näo-transmissíveis: inquérito domiciliar no município de São Paulo, SP (Brasil). Metodologia e resultados preliminares. [Risk factors for chronic non-communicable diseases: a domiciliary survey in the municipality of São Paulo, SP (Brazil). Methodology and preliminary results]. Rev Saude Publica. 1990;24(4):277-85.
Lewis BS, Lynch WD. The effect of physician advice on exercise behavior. Prev Med. 1993;22(1):110-21.
Brasil. Ministério do Planejamento, Orçamento e Gestão. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional por amostra de domicílios. Acesso e utilização de serviços de saúde. Available from: http://www.ibge.gov.br/home/estatistica/populacao/trabalhoerendimento/pnad98/saude/default.shtm. Accessed in 2007 (Feb 21).
US Department of Health and Human Services. Healthy People 2010: Understanding and improving health. Washington, DC: US Government Printing Office; 2000. Available from URL: http://www.healthypeople.gov/Document/tableofcontents.htm#under. Accessed in 2007 (Mar 16).
Guide to clinical preventive services. 2nd ed. Available from URL: http://odphp.osophs.dhhs.gov/pubs/guidecps/. Accessed in 2007 (Mar 16).
Damush TM, Stewart AL, Mills KM, King AC, Ritter PL. Prevalence and correlates of physician recommendations to exercise among older adults. J Gerontol A Biol Sci Med Sci. 1999;54(8):M423-7.
Wee CC, McCarthy EP, Davis RB, Phillips RS. Physician coun- seling about exercise. JAMA. 1999;282(16):1583-8.
Nawaz H, Adams ML, Katz DL. Physician-patient interac- tions regarding diet, exercise, and smoking. Prev Med. 2000;31(6):652-7.
Kreuter MW, Scharff DP, Brennan LK, Lukwago SN. Physician recommendations for diet and physical activity: which patients get advised to change? Prev Med. 1997;26(6):825-33.
Wechsler H, Levine S, Idelson RK, Rohman M, Taylor JO. The physician’s role in health promotion--a survey of primary-care practitioners. N Engl J Med. 1983;308(2):97-100.
Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic car- diovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circula- tion. 2003;107(24):3109-16.
American College of Sports Medicine. Guidelines for exercise testing and prescription. 4th ed. Philadelphia: Lea & Febiger; 1991.
Gibbons RJ, Balady GJ, Beasley JW, et al. ACC/AHA Guide- lines for Exercise Testing. A report of the American College of Cardiology/American Hearth Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol. 1997;30(1):260-311.
American College of Sports Medicine Position Stand and American Heart Association. Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Med Sci Sports Exerc. 1998;30(6):1009-18.
Thomas S, Reading J, Shephard RJ. Revision of the Physical Activity Readiness Questionnaire (PAR-Q). Can J Sport Sci. 1992;17(4):338-45.
American College of Sports Medicine position stand. The rec- ommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc. 1990;22(2):265-74.
DeBusk RF, Stenestrand U, Sheehan M, Haskell WL. Training effects of long versus short bouts of exercise in healthy subjects. Am J Cardiol. 1990;65(15):1010-3.
Dunn AL, Marcus BH, Kampert JB, Garcia ME, Kohl HW 3rd, Blair SN. Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial. JAMA. 1999;281(4):327-34.
Jakicic JM, Wing RR, Butler BA, Robertson RJ. Prescribing exercise in multiple short bouts versus one continuous bout: effects on adherence, cardiorespiratory fitness, and weight loss in overweight women. Int J Obes Relat Metab Disord. 1995;19(12):893-901.
Murphy MH, Hardman AE. Training effects of short and long bouts of brisk walking in sedentary women. Med Sci Sports Exerc. 1998;30(1):152-7.
Schnohr P, Scharling H, Jensen JS. Changes in leisure- time physical activity and risk of death: an observa- tional study of 7,000 men and women. Am J Epidemiol. 2003;158(7):639-44.
Blair SN, LaMonte MJ, Nichaman MZ. The evolution of physical activity recommendations: how much is enough? Am J Clin Nutr. 2004;79(5)913S-920S.
Sallis J, Owen N. Physical activity and behavioral medicine. Thousand Oaks: Sage Publications; 1999.
Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice Hall; 1986.
Prochaska JO, DiClemente CC. Stages and processes of self- change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390-5.
Sallis JF, Hovell MF, Hofstetter CR, Barrington E. Explanation of vigorous physical activity during two years using social learn- ing variables. Soc Sci Med. 1992;34(1):25-32.
Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191-215.
Marcus BH, Simkin LR. The transtheoretical model: ap- plications to exercise behavior. Med Sci Sports Exerc. 1994;26(11):1400-4.
Prochaska J, Redding C, Evers K. The transtheoretical model and stages of change. In: Glanz K, Lewis FM, Rimer BK, editors. Health behavior and health education: theory, research and practice. San Francisco: Jossey-Bass Publishers; 1997. p. 60-84.
Marcus BH, Selby VC, Niaura RS, Rossi JS. Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport. 1992;63(1):60-6.
Marcus B, Sallis J. Determinants of physical activity behavior and implications for interventions. In: Leon AS, editor. Physical activity and cardiovascular health: A National Consensus. Champaing: Human Kinetics Publishers; 1997. p. 192-201.
Chinn DJ, White M, Harland J, Drinkwater C, Raybould S. Barriers to physical activity and socioeconomic position: implications for health promotion. J Epidemiol Community Health. 1999;53(3):191-2.
Araújo TL, Andrade DR, Matsudo SMM, et al. Behavior stages and barriers related to physical activity. FIMS World Congress Abstracts Program; 1998. p. 40.
Matsudo S, Matsudo V. Physical activity and ageing in develop- ing countries. In: Bailey S, editor. Women, sport and physical activity: Perpectives — The multidisciplinary series of physical education and sport science. Physical activity and ageing. In- ternational Council of Sport Science and Physical Education; 2000. p. 65-82.
Andrade D, Figueira A, Araujo T, Matsudo V, Matsudo S, Andrade E. Barriers to adhesion among activity young adults. Med Sci Sports Exerc. 1998;30(5 Suppl):S182. [abstract].
Sallis J, Owen N. Ecological models. health behavior and health education. In: Glanz K, Lewis FM, Rimer BK, editors. Health behavior and health education: theory, research and practice. 2nd ed. San Francisco: Jossey Bass Publishers; 1997. p. 403-24.
Tai SS, Gould M, Smith P, Iliffe S. Promoting physical activity in general practice: should prescribed exercise be free J R Soc Med. 1999;92(2):65-7.
Patrick K, Sallis JF, Long B, et al. A new tool for encour- aging physical activity: Project PACE. Phys Sportsmed. 1994;22(11):45-55.
Calfas K, Sallis J, Oldenburg B, Frech M. The impact of health-care providers on physical activity. In: Leon A, edi- tor. Physical activity and cardiovascular health: A National Consensus. Champaing: Human Kinetics Publishers; 1997. p. 245-51.
Pinto BM, Goldstein MG, DePue JD, Milan FB. Acceptability and feasibility of physician-based activity counseling. The PAL project. Am J Prev Med. 1998;15(2):95-102.
Blair SN, Applegate WB, Dunn AL, et al. Activity Coun- seling Trial (ACT): rationale, design, and methods. Activ- ity Counseling Trial Research Group. Med Sci Sports Exerc. 1998;30(7):1097-106.
Writing Group for the Activity Counseling Trial Research Group. Effects of physical activity counseling in primary care: the Ac- tivity Counseling Trial: a randomized controlled trial. JAMA. 2001;286(6): 677-87.
Albright CL, Cohen S, Gibbons L, et al. Incorporating physical activity advice into primary care: physician-delivered advice within the activity counseling trial. Am J Prev Med. 2000:18(3):225-34.
Matsudo SM, Matsudo VR. Coalitions and networks: facilitat- ing global physical activity promotion. IUHPE – Promotion & Education. XIII, 2; 2006. Available from URL: http://www. agitasp.org.br/material/arquivos/Matsudo-Promotion-Health- 2006-ENG.pdf. Accessed in 2007 (Mar 16).
McClellan W. The physician and patient education: a review. Patient Educ Couns. 1986;8(2):151-63.
Campbell MJ, Browne D, Waters WE. Can general practitioners influence exercise habits Controlled trial. Br Med J (Clin Res Ed). 1985;290(6474):1044-6.
Logsdon DN, Lazaro CM, Meier RV. The feasibility of behav- ioral risk reduction in primary medical care. Am J Prev Med. 1989;5(5):249-56.
Balde A, Figueras J, Hawking DA, Miller JR. Physician ad- vice to the elderly about physical activity. J Aging Phys Act. 2003;11(1):90-7.
Calfas KJ, Long BJ, Sallis JF, Wooten WJ, Pratt M, Patrick K. A controlled trial of physician counseling to promote the adoption of physical activity. Prev Med. 1996;25(3):225-33.
Swinburn BA, Walter LG, Arroll B, Tilyard MW, Russell DG. The green prescription study: a randomized controlled trial of a written exercise advice provided by general practitioners. Am J Public Health. 1998;88(2):288-91.
Petrella RJ, Lattanzio CN. Does counseling help patients get active? Systematic review of the literature. Can Fam Physician. 2002;48:72-80.
Kreuter MW, Chheda SG, Bull FC. How does physician advice influence patient behavior Evidence for a priming effect. Arch Fam Med. 2000;9(5):426-33.
Campbell MK, DeVellis BM, Stretcher VJ, Ammerman AS, DeVellis RF, Sandler RS. Improving dietary behavior: the ef- fectiveness of tailored messages in primary care settings. Am J Public Health. 1994;84(5):783-7.
Petty RT, Cacioppo JT, Strathman AJ, Priester JR. To think or not to think: exploring two routes to persuasion. In: Shavitt S, Brock TC, editors. Persuasion: Psychological insights and perspectives. Boston: Allyn and Bacon; 1994. p. 81-116.
Skinner CS, Siegfried JC, Kegler MC, Stretcher VJ. The po- tential of computers in patient education. Patient Educ Couns. 1993;22(1):27-34.
Marshall AL, Smith BJ, Bauman AE, Kaur S. Reliability and validity of a brief physical activity assessment for use by family doctors. Br J Sports Med. 2005;39(5):294-7; discussion 294-7.
Downloads
Publicado
Como Citar
Edição
Seção
Licença

Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.