https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60646-1.pdf

Global physical activity levels: surveillance progress, pitfalls, and prospects

Ten per cent of the world’s school-aged children are estimated to be carrying excess body fat (Fig. 1), with an increased risk for developing chronic disease. Of these overweight children, a quarter are obese, with a significant likelihood of some having multiple risk factors for type 2 diabetes, heart disease and a variety of other co-morbidities before or during early adulthood. The prevalence of overweight is dramatically higher in economically developed regions, but is rising significantly in most parts of the world. In many countries the problem of childhood obesity is worsening at a dramatic rate. Surveys during the 1990s show that in Brazil and the USA, an additional 0.5% of the entire child population became overweight each year. In Canada, Australia and parts of Europe the rates were higher, with an additional 1% of all children becoming overweight each year. The burden upon the health services cannot yet be estimated. Although childhood obesity brings a number of additional problems in its train – hyperinsulinaemia, poor glucose tolerance and a raised risk of type 2 diabetes, hypertension, sleep apnoea, social exclusion and depression – the greatest health problems will be seen in the next generation of adults as the present childhood obesity epidemic passes through to adulthood. Greatly increased rates of heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis, endocrine disorders and other obesityrelated conditions will be found in young adult populations, and their need for medical treatment may last for their remaining life-times. The costs to the health services, the losses to society and the burdens carried by the individuals involved will be great. The present report has been written to focus attention on the issue and to urge policy-makers to consider taking action before it is too late. Specifically, the report:

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-789X.2004.00133.x

Obesity in children and young people: a crisis in public health.

https://www.zora.uzh.ch/id/eprint/69552/1/PIIS0140673612608988.pdf

The pandemic of physical inactivity: global action for public health

OBJECTIVE
To identify factors in childhood which might influence the development of obesity in adulthood.


BACKGROUND
The prevalence of obesity is increasing in the UK and other developed countries, in adults and children. The adverse health consequences of adult obesity are well documented, but are less certain for childhood obesity. An association between fatness in adolescence and undesirable socio-economic consequences, such as lower educational attainment and income, has been observed, particularly for women. Childhood factors implicated in the development of adult obesity therefore have far-reaching implications for costs to the health-services and economy.


SEARCH STRATEGY
In order to identify relevant studies, electronic databases--Medline, Embase, CAB abstracts, Psyclit and Sport Discus-were searched from the start date of the database to Spring 1998. The general search structure for electronic databases was (childhood or synonyms) AND (fatness or synonyms) AND (longitudinal or synonyms). Further studies were identified by citations in retrieved papers and by consultation with experts.


INCLUSION CRITERIA
Longitudinal observational studies of healthy children which included measurement of a risk factor in childhood (<18 y), and outcome measure at least 1 y later. Any measure of fatness, leanness or change in fatness or leanness was accepted. Measures of fat distribution were not included. Only studies with participants from an industrialized country were considered, and those concerning minority or special groups, e.g. Pima Indians or children born preterm, were excluded.


FINDINGS
Risk factors for obesity included parental fatness, social factors, birth weight, timing or rate of maturation, physical activity, dietary factors and other behavioural or psychological factors. Offspring of obese parent(s) were consistently seen to be at increased risk of fatness, although few studies have looked at this relationship over longer periods of childhood and into adulthood. The relative contributions of genes and inherited lifestyle factors to the parent-child fatness association remain largely unknown. No clear relationship is reported between socio-economic status (SES) in early life and childhood fatness. However, a strong consistent relationship is observed between low SES in early life and increased fatness in adulthood. Studies investigating SES were generally large but very few considered confounding by parental fatness. Women who change social class (social mobility) show the prevalence of obesity of the class they join, an association which is not present in men. The influence of other social factors such as family size, number of parents at home and childcare have been little researched. There is good evidence from large and reasonably long-term studies for an apparently clear relationship for increased fatness with higher birth weight, but in studies which attempted to address potential confounding by gestational age, parental fatness, or social group, the relationship was less consistent. The relationship between earlier maturation and greater subsequent fatness was investigated in predominantly smaller, but also a few large studies. Again, this relationship appeared to be consistent, but in general, the studies had not investigated whether there was confounding by other factors, including parental fatness, SES, earlier fatness in childhood, or dietary or activity behaviours. Studies investigating the role of diet or activity were generally small, and included diverse methods of risk factor measurement. There was almost no evidence for an influence of activity in infancy on later fatness, and inconsistent but suggestive evidence for a protective effect of activity in childhood on later fatness. No clear evidence for an effect of infant feeding on later fatness emerged, but follow-up to adulthood was rare, with only one study measuring fatness after 7y. Studies investigating diet in childhood were limited and inconc

Childhood predictors of adult obesity: a systematic review.

http://www.ernaehrungsdenkwerkstatt.de/fileadmin/user_upload/EDWText/Personen/Popkin_Nutrition_Transition_global__dynamics_AJCN_84_289_2006.pdf

Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases

Este estudo e parte de um esforco internacional para validar um questionario internacional de atividade fisica (IPAQ) proposto pela Organizacao Mundial de Saude (1998), e que pretende servir como um instrumento mundial para determinar o nivel de atividade fisica em nivel populacional. O objetivo deste estudo foi determinar a validade do IPAQ em uma amostra de adultos brasileiros. A amostra foi consti­tuida por257 homens e mulheres que responderam o IPAQ (versao da ultima semana, formas curta e longa) no inicio do estudo e apos 7 dias. Para validar o instrumento parte da amostra (n:.28) usou o sensor de movimento Computer Science & Aplications (CSA). A reprodutibilidade do questionario foi determinada depois de 7 dias e a correlacao de Spearman foi significante e alta (rho=0,69 - 0,71:p

/pdf/questionario-internacional-de-atividade-fisica-ipaq-estupo-1i6tfnelhc.pdf

Questionário internacional de atividade física (ipaq): estupo de validade e reprodutibilidade no brasil

The purpose of this paper is to present key points of an intervention programme (Agita Sao Paulo Program) to promote physical activity in a developing country. Agita is a multi-level, community-wide intervention designed to increase knowledge about the benefits and the level of physical activity in a mega-population of 34 million inhabitants of Sao Paulo State, Brazil. The main message was taken from the Centers for Disease Control/American College of Sports Medicine (CDC/ACSM) recommen- dation that: 'everyone should accumulate at least 30 minutes of physical activity, on most days of the weeks, of moderate intensity, in one single or in multiple sessions'. Activities were encouraged in three settings: home, transport and leisure time. Focus groups were students from elementary schools through to college, white and blue collar workers, and elderly people. Innovative aspects included: (1) a research centre leading the process, (2) scientific and institutional partnerships (over 160 groups), (3) a feasible approach - the 'one-step-ahead' model, (4) empowerment, (5) inclusion, (6) non-paid media, (7) social marketing, and (8) culture-linked. Data were obtained from 645 random, home-based questionnaires over four years - stratified by sex, age, education and socio-economic level. These data show that the Agita message reached 55.7% of the population, and among these, 23.1% knew the main message. Recall of Agita and knowledge of its purpose were well distributed among different socio- economic levels, being known by 67% of the most educated. The prevalence of people reaching the recommendation was 54.8% (men 48.7%, women 61%); and risk of being sedentary was quite smaller among those who knew the Agita message (7.1%) compared with those who did not know (13.1%). In conclusion, based upon the Agita Sao Paulo experience, it appears that a multi-level, community-wide intervention to promote physical activity may obtain good results if the model contains the items listed above.

/pdf/promotion-of-physical-activity-in-a-developing-country-the-kpfm6hsbsm.pdf

Promotion of physical activity in a developing country: the Agita São Paulo experience.

The "Agita Sao Paulo" Program applies a multilevel intervention approach to promoting physical activity among the 37 million inhabitants of the state of Sao Paulo, Brazil. The verb "agita" means to move the body, but the term also suggests changing the way of thinking and becoming a more active citizen. Since being launched in 1996, the Program has been widely copied throughout Brazil and in other countries of Latin America, and the World Health Organization has characterized it as a model for other developing countries. The Program aims to disseminate a clear and simple message to the community as well as establish partnerships with governmental and nongovernmental organizations and other entities. The Agita Sao Paulo message encourages people to adopt an active lifestyle by accumulating at least 30 minutes of moderate physical activity per day, on most days of the week. The Program has three main target groups: students, workers, and the elderly. The Program organizes "mega-events" that simultaneously reach and involve large numbers of people, and it also conducts ongoing activities with institutions that become partners of the Program. Intervention studies that the Program has carried out on specific, small groups have found both changes in behavior and an increasing awareness of the Program's name and message. In addition, surveys have found that a growing number of persons in the state of Sao Paulo have become aware of the Program and its message and have changed their physical activity level. A number of the special features of and lessons learned from the Agita Sao Paulo Program may have contributed to its success, including: a multisectorial approach; broad use of partnerships; the inclusion principle (avoiding messages or attitudes that might exclude any social group); the scientific basis for all the Program activities; the extensive free media coverage that the Program has received; a "two-hats" approach, using either governmental or nongovernmental methodologies to promote physical activity, depending on the circumstances; cultural adaptation (using local culture to disseminate the message and make its assimilation easier); encouraging activities that are pleasurable; the clear, simple, feasible message of promoting physical activity; and evaluation of the various Program efforts. These distinctive characteristics help make the Agita Sao Paulo Program a model that could be used in other countries as an effective way to promote health through physical activity.

/pdf/the-agita-sao-paulo-program-as-a-model-for-using-physical-4v4fj4mfqy.pdf

The Agita São Paulo Program as a model for using physical activity to promote health

Objective: To describe the prevalence of physical inactivity and associated factors among high school students from state’s public schools in the city of Sao Paulo, state of Sao Paulo, Brazil. Methods: Sixteen state’s public schools were randomly selected according to the geographic areas of the city (North, South, East, and West). The sample consisted of 3,845 high school students in 2006. Physical inactivity was measured using the International Physical Activity Questionnaire (short IPAQ) and was defined as practicing moderate and/or vigorous physical activity for a period of less than 300 minutes per week. The independent variables analyzed were: gender, age, socioeconomic level, geographic area of the city, awareness of the “Agita Sao Paulo” program, participation in physical education classes, smoking, alcohol intake and time spent per day watching television. Threelevel Poisson regression was used for assessing the variables, with a significance level of p < 0.05. Results: The general prevalence of physical inactivity among adolescents in Sao Paulo was 62.5% (95%CI 60.5-64.1). The factors associated with physical inactivity were gender, age, socioeconomic level, geographic area of the city, awareness of the “Agita Sao Paulo” program, non-participation in physical education classes, smoking, alcohol intake and time spent per day watching television. Conclusion: It was concluded that the prevalence of physical inactivity among adolescents in Sao Paulo was high in all the geographic areas evaluated, and that sociodemographic and behavioral factors contributed significantly to physical inactivity.

Prevalence of physical inactivity and associated factors among high school students from state's public schools.

OBJECTIVE: To describe the prevalence of physical inactivity and associated factors among high school students from state's public schools in the city of Sao Paulo, state of Sao Paulo, Brazil. METHODS: Sixteen state's public schools were randomly selected according to the geographic areas of the city (North, South, East, and West). The sample consisted of 3,845 high school students in 2006. Physical inactivity was measured using the International Physical Activity Questionnaire (short IPAQ) and was defined as practicing moderate and/or vigorous physical activity for a period of less than 300 minutes per week. The independent variables analyzed were: gender, age, socioeconomic level, geographic area of the city, awareness of the "Agita Sao Paulo" program, participation in physical education classes, smoking, alcohol intake and time spent per day watching television. Three-level Poisson regression was used for assessing the variables, with a significance level of p < 0.05. RESULTS: The general prevalence of physical inactivity among adolescents in Sao Paulo was 62.5% (95%CI 60.5-64.1). The factors associated with physical inactivity were gender, age, socioeconomic level, geographic area of the city, awareness of the "Agita Sao Paulo" program, non-participation in physical education classes, smoking, alcohol intake and time spent per day watching television. CONCLUSION: It was concluded that the prevalence of physical inactivity among adolescents in Sao Paulo was high in all the geographic areas evaluated, and that sociodemographic and behavioral factors contributed significantly to physical inactivity.

http://www.scielo.br/pdf/jped/v85n4/en_v85n4a06.pdf

Luis C. Oliveira

Papers

Questionário internacional de atividade física (ipaq): estupo de validade e reprodutibilidade no brasil

Promotion of physical activity in a developing country: the Agita São Paulo experience.

The Agita São Paulo Program as a model for using physical activity to promote health

Prevalence of physical inactivity and associated factors among high school students from state's public schools.

Prevalência de inatividade física e fatores associados em estudantes do ensino médio de escolas públicas estaduais