Resumen: La actividad física en el ocio parece relevante para prevenir el desarrollo de enfermedades crónicas y la obesidad. Sin embargo, poco se sabe sobre el impacto económico de estos comportamientos saludables, especialmente en estudios longitudinales. El objetivo de este estudio fue analizar el impacto de caminar y andar en bicicleta como actividades de ocio sobre la adiposidad y los costos de salud en adultos. Este estudio longitudinal se llevó a cabo en una ciudad brasileña de tamaño mediano e incluyó a 198 participantes sin datos indisponibles atendidos en el Sistema Único de Salud brasileño. Se evaluaron los hábitos de caminar y andar en bicicleta mediante un cuestionario y una entrevista cara a cara en cuatro momentos (inicial, 6 meses, 12 meses y 18 meses). Los costos de atención médica se evaluaron utilizando registros médicos. Los marcadores de adiposidad incluyeron la circunferencia de la cintura y la grasa corporal. Durante el período de seguimiento, los participantes que practicaban más ciclismo presentaron menos grasa corporal (p = 0,028) y costos de salud (p = 0,038). Sin embargo, en el modelo multivariado, el impacto del ciclismo en los costos dejó de ser significativo (p = 0,507) debido al impacto del número de enfermedades crónicas (p = 0,001). El hábito de andar en bicicleta en los momentos de ocio está inversamente relacionado con la adiposidad en los adultos, mientras que su papel en la prevención de enfermedades crónicas parece ser el principal aspecto que lo vincula con la reducción de costos.

Abstract: Leisure-time physical activity seems relevant to prevent the development of chronic diseases and obesity. However, not much is known about the economic burden of these healthy behaviors, mainly in longitudinal designs. This study aimed to analyze the impact of walking and cycling on leisure-time on adiposity and healthcare costs among adults. This longitudinal study was conducted at a medium-size Brazilian city and included 198 participants with no missing data attended in the Brazilian Unified National Health System. Cycling and walking were assessed by a questionnaire with a face-to-face interview at four time-points (baseline, 6-month, 12-month, and 18-month). Healthcare costs were assessed using medical records. Adiposity markers included waist circumference and body fatness. Over the follow-up period, participants who were more engaged in cycling presented lower body fatness (p-value = 0.028) and healthcare costs (p-value = 0.038). However, in the multivariate model, the impact of cycling on costs was not significant (p-value = 0.507) due to the impact of number of chronic diseases (p-value = 0.001). Cycling on leisure-time is inversely related to adiposity in adults, whereas its role on preventing chronic diseases seems the main pathway linking it to cost mitigation.

Resumo: A atividade física no lazer parece relevante para prevenir o desenvolvimento de doenças crônicas e obesidade. No entanto, pouco se sabe sobre o impacto econômico destes comportamentos saudáveis, principalmente em estudos longitudinais. O objetivo deste estudo foi analisar o impacto da caminhada e do ciclismo como atividades de lazer na adiposidade e nos custos de saúde em adultos. Este estudo longitudinal foi realizado em uma cidade brasileira de médio porte e incluiu 198 participantes sem dados indisponíveis atendidos no Sistema Único de Saúde brasileiro. A caminhada e o ciclismo foram avaliados por meio de questionário e entrevista presencial em quatro momentos (linha de base, 6 meses, 12 meses e 18 meses). Os custos de saúde foram avaliados por meio de prontuários médicos. Os marcadores de adiposidade incluíram circunferência da cintura e gordura corporal. Durante o período de acompanhamento, os participantes que praticavam mais ciclismo apresentaram menos gordura corporal (p = 0,028) e custos de saúde (p = 0,038). Porém, no modelo multivariado, o impacto do ciclismo nos custos deixou de ser significativo (p = 0,507) devido ao impacto do número de doenças crônicas (p = 0,001). O ciclismo no momento de lazer está inversamente relacionado à adiposidade em adultos, enquanto o seu papel na prevenção de doenças crônicas parece ser o principal aspecto que o liga à redução de custos.

ABSTRACT BACKGROUND: Research on the economic burden of sedentary behavior and abdominal obesity on health expenses associated with cardiovascular diseases is scarce. OBJECTIVE: The objective of this study was to verify whether sedentary behavior, isolated and combined with abdominal obesity, influences the medication expenditure among adults with cardiovascular diseases. DESIGN AND SETTING: This cross-sectional study was conducted in the city of President Prudente, State of São Paulo, Brazil in 2018. METHODS: The study included adults with cardiovascular diseases, aged 30-65 years, who were treated by the Brazilian National Health Services. Sedentary behavior was assessed using a questionnaire. Abdominal obesity was defined by waist circumference. Medication expenditures were verified using the medical records of each patient. RESULTS: The study included a total of 307 adults. Individuals classified in the group with risk factor obesity combined (median [IQ] USD$ 29.39 [45.77]) or isolated (median [IQ] USD$ 27.17 [59.76]) to sedentary behavior had higher medication expenditures than those belonging to the non-obese with low sedentary behavior group (median [IQ] USD$ 13.51 [31.42]) (P = 0.01). The group with combined obesity and sedentary behavior was 2.4 (95%CI = 1.00; 5.79) times more likely to be hypertensive. CONCLUSION: Abdominal obesity was a determining factor for medication expenses, regardless of sedentary behavior, among adults with cardiovascular diseases.

Abstract Aim: The study aimed to conduct a cost-utility analysis of traditional drug therapy (TDT) provided for hypertensive patients at primary care in comparison to the protocol based on combination with an exercise program (TDT+E) in real-life conditions, adopting a health system perspective. Methods: Longitudinal study based on enrollment of 49 hypertensive adults distributed into two groups, for 12 months. Quality-adjusted life years were estimated using health-related quality of life. Direct health care costs were calculated including inputs and human resources in primary care from medical records. Sensitivity analysis was performed based on multivariate and probabilistic scenarios. Results: Incremental cost-effectiveness ratios of TDT+E in comparison to TDT were +79.69. Sensitivity analysis showed that TDT+E presented advantages considering uncertainties. Conclusion: Our findings show that exercise programs may improve quality of life and life expectancy among hypertensive patients.

ABSTRACT BACKGROUND: Physical activity (PA) practices seem to differ between weekdays and weekends and these pattern changes can affect body fat differently. However, previous studies did not assess the mediation effect of weekday and weekend PA on maintenance of body fat using sophisticated statistical models. OBJECTIVE: To analyze the mediation effect of PA during weekdays and weekends on maintenance of fat mass over a 12-month follow-up. DESIGN AND SETTING: Longitudinal cohort study (12 months) conducted at a public university in Presidente Prudente, Brazil. METHODS: A sample of 225 adults (117 females) was used. Body fatness and fat mass were assessed using dual-energy X-ray absorptiometry. PA levels were assessed using a pedometer. The statistical analysis consisted of paired-sample t tests, independent-sample t tests, Pearson correlations and mediation models. RESULTS: After 12 months, weekend PA had decreased while body composition indicators remained stable (without changes). The correlation between fat mass at baseline and follow-up was high for both sexes (men: 0.966; women: 0.941; P-value = 0.001 for both). Moreover, PA indices were inversely but moderately related to fat mass at baseline and follow-up. Lastly, weekend PA mediated the association between fat mass at baseline and follow-up (P-value < 0.05) by around 2% and 4%. CONCLUSION: Weekend PA mediated the association between fat mass at baseline and fat mass after one year of follow-up among these adults. Further studies are required to investigate the association between physical activity, body fat and other variables such as dietary patterns and sleep time.

BACKGROUND: This study was based on filling a gap in our knowledge regarding the issue of what the protective effect of physical exercise on patients within the Brazilian National Health System could be, in relation to low back pain. OBJECTIVES: To determine the prevalence of chronic low back pain (CLBP) and to analyze the protective effect of physical exercise among patients over 50 years old attended at primary healthcare units (PHUs). DESIGN AND SETTING: Analytical cross-sectional study at Universidade Estadual Paulista (UNESP) that was conducted in two PHUs (Parque Cedral and Vila Real), located in different regions of the city of Presidente Prudente, Brazil. METHODS: In total, 327 patients were interviewed and evaluated at which retrospective characteristics covering the previous 12 months. The Nordic questionnaire was used to classify CLBP, and the Baecke questionnaire for physical activity level. The body mass index (kg/m2) was calculated using body mass and height values, both collected at the time of the interview. RESULTS: High prevalence of low back pain was found; 175 patients (53.5%) reported having had at least one episode of low back pain in the previous year. Of these, 71 (21.7%) answered yes to all four questions on the Nordic questionnaire and were classified as CLBP. Physical exercise remained associated with CLBP, independent of other factors (odds ratio = 0.35; 95% confidence interval = 0.15-0.80). CONCLUSION: High prevalence of low back pain was identified among PHU users. Physical exercise was associated as an independent protective factor against this pathological condition.

Resumo Fundamento: O estilo de vida pouco saudável está se expandindo e isso pode ter repercussões no estado de saúde, exigindo ações contra a ocorrência de doenças e levando ao aumento de gastos. Objetivo: Examinar a interrelação entre os custos do uso de medicamentos e comportamentos de estilo de vida. Métodos: Estudo de coorte com 118 participantes com idade de 51,7 ± 7,1 anos. Foram coletados dados pessoais e antropométricos e informações sobre medicamentos de uso contínuo para calcular os custos. As variáveis de estilo de vida incluíram: atividade física (AF) habitual, avaliada por pedômetro; comportamento sedentário, pelo questionário de Baecke; qualidade do sono, através do Mini Questionário do Sono, e autorrelato de tabagismo e consumo de álcool. As análises estatísticas foram realizadas no programa BioEstat (versão 5.2), e o nível de significância estabelecido como p < 0,05. Resultados: Em 12 meses, 62 indivíduos compraram 172 medicamentos, representando um custo total de US$ 3.087,01. Gastos com medicamentos foram negativamente relacionados à AF (r = -0,194, p-valor = 0,035 e r = -0,281, p-valor = 0,002), mas relacionaram-se positivamente com a qualidade do sono (r = 0,299, p-valor=0,001 e r=0,315, p-valor = 0,001) e idade (r = 0,274, p-valor = 0,003). Quatro modelos multivariados foram executados, considerando os comportamentos de estilo de vida em diferentes momentos da coorte e custos dos medicamentos, e todos esses modelos identificam relações importantes entre comportamentos de estilo de vida e gastos com medicamentos. Conclusão: A pior qualidade do sono parece aumentar os custos relacionados ao uso de medicamentos em adultos, enquanto a obesidade e o envelhecimento desempenham um papel relevante nesse fenômeno, e o consumo de álcool parece ser uma variável com impacto econômico significativo.

Abstract Background: The unhealthy lifestyle is growing and this can have repercussions on health status demanding actions on the occurrence of diseases and leads to increased expenses. Objective: To examine the interrelationship between the costs of medicine use and lifestyle behaviors. Methods: A cohort study with 118 participants, age around 51.7 ± 7.1 years old. It was collected personal and anthropometric data and information about medicine of continuous use to calculate the costs. Lifestyle variables included habitual physical activity (PA) assessed by pedometer, sedentary behavior by Baecke questionnaire, sleep quality by mini sleep questionnaire and self-report of smoke and alcohol consumption. Statistical analyses were performed by BioEstat (version 5.2) and the significance level set at p-value < 0.05. Results: In 12 months, 62 subjects bought 172 medicines, representing an overall cost of US$ 3,087.01. Expenditures with drugs were negatively related to PA (r = -0.194, p-value = 0.035 and r = -0.281, p-value = 0.002), but positively related with sleep quality (r = 0.299, p-value=0.001 and r = 0.315, p-value = 0.001) and age (r = 0.274, p-value = 0.003). Four multivariate models were executed considering lifestyle behaviors in different moments of cohort and medicine costs, and all these models identify important relationship between lifestyle behaviors with expenditures with drugs. Conclusion: Worse sleep quality seems to increase the costs related to medicine use in adults, while obesity and ageing play a relevant role in this phenomenon and alcohol consumption seems a variable with relevant economic impact.

RESUMO O objetivo desse estudo foi descrever e analisar o condicionamento físico de alunos de graduação do curso de Educação Física. A amostra foi composta por 110 mulheres e 115 homens. Foram avaliados peso, altura, índice de massa corpórea, percentual de gordura corporal (GC), frequência cardíaca em repouso (FCR), pressão arterial sistólica (PAS) e diastólica, flexibilidade, força e resistência muscular localizada (RML). Como principais resultados observou-se maior porcentagem de mulheres com gordura corporal e RML acima dos valores ideais para a idade quando comparados aos homens (GC: 37% vs 4%, p= 0,001; RML: 32% vs 13%, p= 0,001), enquanto houveram mais homens com alteração na PAS quando confrontado com mulheres (22% vs 6%, p= 0,001). Em conclusão, estudantes do sexo masculino apresentaram maiores níveis de aptidão física em relação às mulheres, e parcela expressiva de alunos de Educação Física apresentam alterações nos valores de referência à normalidade para variáveis antropométricas, hemodinâmicas e de desempenho motor.

ABSTRACT The aim of this study was to describe and analyze physical fitness of undergraduate students in Physical Education. The sample consisted of 110 women and 115 men. We evaluated weight, height, body mass index, percentage of body fat (BF), heart rate, systolic blood pressure (SBP), diastolic blood pressure, flexibility, strength and muscular endurance (ME). As main results we observed a higher percentage of women with body fat and ME above the ideal values for age when compared to men (BF: 37% vs 4%, p = 0.001; ME: 32% vs 13%, p = 0.001), while there were more men with changes in SBP when compared with women (22% vs 6%, p = 0.001). In conclusion, male students had higher levels of physical fitness than women, and a significant portion of undergraduate students in Physical Education showed results different than normal for anthropometric, hemodynamic and performance variables.

RESUMO CONTEXTO E OBJETIVO: Neste estudo longitudinal, o objetivo foi descrever as tendências temporais de atividade física (AF) em diferentes domínios de 2010 a 2014 entre usuários do Sistema Único de Saúde, levando em conta o efeito do sexo, idade e condição econômica (CE). TIPO DE ESTUDO E LOCAL: Estudo longitudinal realizado em cinco Unidades Básicas de Saúde em Bauru (SP), Brasil. MÉTODOS: A amostra foi composta de 620 homens e mulheres que foram entrevistados em 2010, 2012 e 2014. O mesmo grupo de pesquisadores realizou as entrevistas utilizando o questionário desenvolvido por Baecke et al. Escores da AF ocupacional, exercícios/esportes, lazer/transporte e AF global foram considerados neste estudo longitudinal. Tendências temporais de AF nos quatro anos de seguimento foram avaliados de acordo com sexo, idade e CE. RESULTADOS: Verificou-se que, após quatro anos de seguimento, a redução da AF total (-13,6%; intervalo de confiança, IC 95% = -11,9 a -15,3) foi estatisticamente significativa. Além disso, o declínio no domínio ocupacional e no exercício/participação esportiva foram afetados pela idade, enquanto a redução na AF total foi afetada pelo sexo, idade e CE. CONCLUSÕES: A AF total diminuiu significativamente de 2010 para 2014 em pacientes ambulatoriais do Sistema Único de Saúde, e idade e sexo masculino foram importantes determinantes de AF em seus diferentes domínios.

ABSTRACT CONTEXT AND OBJECTIVE: In this longitudinal study, we aimed to describe time trends of physical activity (PA) in different domains from 2010 to 2014 among users of the Brazilian National Health System, taking into account the effects of sex, age and economic status (ES). DESIGN AND SETTING: Longitudinal study conducted in five primary care units in Bauru (SP), Brazil. METHODS: The sample was composed of 620 men and women who were interviewed in 2010, 2012 and 2014. The same group of researchers conducted the interviews, using the questionnaire developed by Baecke et al. Scores for occupational, exercise/sport, leisure-time/transportation and overall PA were considered in this longitudinal survey. Time trends of PA over the four years of follow-up were assessed according to sex, age and ES. RESULTS: We found that after four years of follow-up, the reduction in overall PA (-13.6%; 95% confidence interval, CI = -11.9 to -15.3) was statistically significant. Additionally, declines in the occupational domain and exercise/sports participation were affected by age, while the reduction in overall PA was affected by sex, age and ES. CONCLUSIONS: Overall PA decreased significantly from 2010 to 2014 among these outpatients of the Brazilian National Health System, and age and male sex were important determinants of PA in its different domains.

Abstract Aims To analyze factors associated with osteoporosis among outpatients of the Brazilian National Health System and to identify their association with hospital and labor economic outcomes. Methods Cross-sectional study carried out in the city of Presidente Prudente / SP. The sample consisted of 542 adults of both sexes and aged ≥ 50 years old. The occurrence of osteoporosis, health-related productivity loss, use of hospital services and level of physical activity were assessed using questionnaires. Statistical analysis was composed of chi-square test, binary logistic regression and Mann-Whitney test. The significance level adopted was p-value <0.05. ResultsThe prevalence of osteoporosis was 14.4% (95% CI: 11.4% - 17.3%) and it was associated with female sex (p = 0.001), lower economic status (p-value = 0.036) and obesity (p-value = 0.003). Participants with osteoporosis showed a higher incidence of surgery in the last 12 months (OR = 2.13 [1.04 to 4.35]), productivity loss (OR = 1.91 [1.13 to 3.42]) and disability retirement (OR = 2.03 [1.20 to 3.43]). Over the past 12 months, the sum of direct and indirect economic loss was R$ 1,382,630.00. Conclusion The female sex, lower economic status and obesity were associated with a higher occurrence of osteoporosis, and consequent higher use of hospital services and significant economic losses.

Abstract AIM The aim of this longitudinal study was to analyze the relationship between sleep disorder and intima-media thickness. METHOD Baseline measurements included carotid intima-media thickness, assessed by an ultrasound device; questionnaires about sleep and other behavioral variables; physical activity was measured by pedometer; body fatness was estimated by Dual-Energy X-ray Absorptiometry; fasting glucose, lipid profile and C-reactive protein were collected. RESULTS The occurrence rate of sleep-related disorders was 47% (95%CI= 37.2%-56.7%). Carotid intima-media thickness was related to symptoms of insomnia (r= 0.328 [0.141 to 0.493]) and, after adjustments for potential confounders, the relationship between carotid intima-media thickness and insomnia remained statistically significant (β= 0.121 [95%CI= 0.017; 0.225]). CONCLUSIONS In young adults, sleep disorder was significantly related to premature increase in carotid intima-media thickness.

Abstract Aims: The promotion of sports participation during the early years of life is important not only because it promotes health during childhood and adolescence, but also because it has benefits in adulthood. This study was developed to identify the association between sports participation during the early years of life and adulthood, to analyze the non-participation in sports throughout life and to identify the correlates of non-participation in sports. DESIGN: Cross-sectional study. Methods: The sample was composed of 743 adults randomly selected in a medium-size Brazilian city. Non-participation in sports during childhood and adolescence was assessed through specific questions, and non-participation in sports in adulthood was assessed using the second section of Baecke questionnaire. Answering “no” in the three periods assessed (childhood, adolescence and adulthood) was characterized as non-participation in sports throughout life. Chronological age, sex, formal education, BMI, current job and ethnicity were considered covariates. Categorical data were expressed as rates and compared using chi-square test and binary logistic regression. Results: The prevalence of adults not engaged in sports throughout life was 58.5% (95% CI= 55.1 - 62.1). Females (OR = 2.41 [1.71 - 3.38]), those more advanced in age (OR = 3.29 [1.82-5.94]) and/or possessing a lower level of education (OR = 4.47 [2.45 - 8.17]) were associated with the non-engagement in sports. Conclusion: Non-participation in sports during childhood can influence non-participation in sports during adulthood, which is significantly affected by sex, age and education level.

ABSTRACT The objectives of this study were to analyze the association between osteoporosis and current/early physical activity and also to identify whether early sport participation, osteoporosis, age and sex are somehow connected. The study sample included 963 participants. Osteoporosis was diagnosed through medical records. Physical activity in current and the early years of life, age, sex and economic condition were assessed through questionnaires. Abdominal obesity was identified by waist circumference. Results showed that osteoporosis was associated with female sex and higher age. Participants that were active in adulthood had 47% lower chance of osteoporosis (odds ration [OR] = 0.53[0.30-0.93]). Adults that were active in childhood and adolescence had a lower chance of osteoporosis only in the crude model (OR = 0.38[0.22-0.64]). Women that were inactive in their youth were almost five times more likely to have osteoporosis when compared to men under the same conditions (OR = 4.80[2.46-9.37]). A lack of sports participation in the early years of life seems to be associated with osteoporosis, age and sex.