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

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ABSTRACT

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, sociodemographic 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.

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Most cited references 46

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International physical activity questionnaire: 12-country reliability and validity.

CORA L. CRAIG, ALISON L. MARSHALL, MICHAEL SJ??STR??M … (2003)

Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity. Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity. Overall, the IPAQ questionnaires produced repeatable data (Spearman's rho clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median rho of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode. The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment.

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World Health Organization 2020 guidelines on physical activity and sedentary behaviour

Fiona Bull, Salih Al-Ansari, Stuart Biddle … (2020)

Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.

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Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants

Regina Guthold, Gretchen Stevens, Leanne Riley … (2018)

Insufficient physical activity is a leading risk factor for non-communicable diseases, and has a negative effect on mental health and quality of life. We describe levels of insufficient physical activity across countries, and estimate global and regional trends.

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Author and article information

Journal

Journal ID (nlm-ta): Sao Paulo Med J

Journal ID (iso-abbrev): Sao Paulo Med J

Journal ID (publisher-id): spmj

Title: São Paulo Medical Journal

Publisher: Associação Paulista de Medicina - APM

ISSN (Print): 1516-3180

ISSN (Electronic): 1806-9460

Publication date (Electronic, pub): 29 August 2022

Publication date (Electronic, collection): Sep-Oct 2022

Volume: 140

Issue: 5

Pages: 658-667

Affiliations

[I ]BHSc. Student, Multiprofessional Residency Program on Family Health, Sergio Arouca National School of Public Health, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro (RJ), Brazil.

[II ]MSc. Researcher, Postgraduate Program on Physical Education and Research Group on Environment, Physical Activity and Health, Universidade Tecnológica Federal do Paraná (UTFPR), Curitiba (PR), Brazil.

[III ]PhD. Professor and Researcher, Postgraduate Program on Physical Education and Study Group on Urban Environment and Health, Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil.

[IV ]PhD. Professor and Researcher, Postgraduate Program on Physical Education and Research Group on Environment, Physical Activity and Health, Universidade Tecnológica Federal do Paraná (UTFPR), Curitiba (PR), Brazil.

[V ]PhD. Researcher, Biomedical/Biotechnology Research Institute, North Carolina Central University (NCCU), Durham (NC), United States.

[VI ]PhD. Professor and Researcher, Department of Physical Education, Universidade Federal do Paraná (UFPR), Curitiba (PR), Brazil.

[VII ]PhD. Professor and Researcher, Postgraduate Program on Physical Education and Research Group on Environment, Physical Activity and Health, Universidade Tecnológica Federal do Paraná (UTFPR), Curitiba (PR), Brazil.

Author notes

Address for correspondence: Rogério César Fermino Programa de Pós-graduação em Educação Física, Universidade Tecnológica Federal do Paraná (UTFPR) R. Pedro Gusso, 2.601 Neoville — Curitiba (PR) — Brasil CEP 81310-900 Tel. (+55 41) 3247-0966 E-mail: rogeriofermino@ 123456utfpr.edu.br

Authors’ contributions: All authors contributed in a relevant way and met the authorship criteria, as suggested by the International Committee of Medical Journal Editors. Souza ALK participated in the initial conception of the study, data collection and analysis, literature review and initial writing of the article. Santos LP participated in the initial conception of the study, planning and coordination of data collection, data analysis, literature review and initial writing of the article. Rech CR and Alberico C collaborated in the initial planning of the project and critical review of the paper. Borges LB collaborated in the initial conception of the project, literature review, writing and critical review. Rodriguez-Añez CR participated in the co-supervision of the project, interpretation of results and critical review of the article. Fermino RC was responsible for the design and coordination of the project, planning the stages, collaborating in data analysis, interpretation of results, literature review, writing and review of the article at all stages. All authors read and approved the final version of the paper

Conflicts of interests: The authors declare that they did not have any conflict of interest