Supervised training in primary care units but not self-directed physical activity lowered cardiovascular risk in Brazilian low-income patients: a controlled trial

Abstract

BackgroundPublic health strategies to increase physical activity in low-income communities may reduce cardiovascular risk in these populations. This controlled trial compared the cardiovascular risk estimated by the Framingham Risk Score (FRS) over 12 months in formally active (FA), declared active (DA), and physically inactive (PI) patients attended by the ‘Family Health Strategy’ in low-income communities at Rio de Janeiro City, Brazil (known as ‘favelas’).MethodsPatients were matched for age and assigned into three groups: a) FA (supervised training, n = 53; 60.5 ± 7.7 yrs); b) DA (self-reported, n = 43; 57.0 ± 11.2 yrs); c) PI (n = 48; 57.0 ± 10.7 yrs). FA performed twice a week a 50-min exercise circuit including strength and aerobic exercises, complemented with 30-min brisk walking on the third day, whereas DA declared to perform self-directed physical activity twice a week. Comparisons were adjusted by sex, chronological age, body mass index, and use of anti-hypertensive/statin medications.ResultsAt baseline, groups were similar in regards to body mass, body mass index, triglycerides, and LDL-C, as well to FRS and most of its components (age, blood pressure, hypertension prevalence, smoking, HDL-C, and total cholesterol; P > 0.05). However, diabetes prevalence was 10–15% lower in DA vs. FA and PI (P < 0.05). Intention-to-treat analysis showed significant reductions after intervention (P < 0.05) in FA for total cholesterol (~ 10%), LDL-C (~ 15%), triglycerides (~ 10%), systolic blood pressure (~ 8%), and diastolic blood pressure (~ 9%). In DA, only LDL-C decreased (~ 10%, P < 0.05). Significant increases were found in PI (P < 0.05) for total cholesterol (~ 15%), LDL-C (~ 12%), triglycerides (~ 15%), and systolic blood pressure (~ 5%). FRS lowered 35% in FA (intention-to-treat, P < 0.05), remained stable in DA (P > 0.05), and increased by 20% in PI (P < 0.05).ConclusionsA supervised multi-modal exercise training developed at primary care health units reduced the cardiovascular risk in adults living in very low-income communities. The risk remained stable in patients practicing self-directed physical activity and increased among individuals who remained physically inactive. These promising results should be considered within public health strategies to prevent cardiovascular disease in communities with limited resources.Trial registrationTCTR20181221002 (retrospectively registered). Registered December 21, 2018.

Association of public physical activity facilities and participation in community programs with leisure-time physical activity: does the association differ according to educational level and income?

“…Although Brazil has a large program that includes PA professionals in primary health care (Multidisciplinary Primary Care Teams), the distribution of the units with PA interventions is unequal considering different geographical regions [ 26 ]. The supervised PA promoted by the different programs already proved to be effective, even in highly deprived areas, such as in “ favelas ” [ 14 , 27 ]. Also, both the building of public PA facilities and the stimulation of community health programs for the stimulation of PA should be taken together.…”

A Critical Review on New Approaches for Chronic Disease Prevention in Brazil and Canada: From Wholistic Dietary Guidelines to Physical Activity Security

“…This situation requires alternative approaches, such as for example, walking meetings, which has been reported to also lead to social benefits ( 161 ), as well as some recently proposed solutions with promising results, including intermittent upper body ergometry, an attractive option for those who prefer to remain in the seated position ( 162 ), and low-cost standing desks, which are made out of cardboard, are suitable for use in different locations such as at home, and can have an inexpensive and environment-friendly recycling process ( 163 , 164 ). Despite the challenges involved in implementing public policies that contemplate widespread access to PA promotion and sedentary behavior reduction initiatives, especially in low-income settings, localized comprehensive interventions have been recently implemented in many countries, including Canada and Brazil, and must be scaled up ( 60 , 101 , 146 , 165 ).…”

“…It is not surprising that modifying one's routine to include PA was shown to be impractical due to different reasons, such as tiresome jobs, long commutes, holding more than one job and/or also studying, and competing housework chores and/or family responsibilities ( 47 , 99 ). Although different barriers to PA are found in specific regions ( 95 , 100 ), low income is associated with PA insecurity in high- as well as lower-income countries ( 47 , 101 ).…”

A Comparative Case Study: Does the Organization of Primary Health Care in Brazil and Turkey Contribute to Reducing Disparities in Access to Care?

“…One recent study aimed to improve the prevention care capacity of the FHS teams by integrating a supervised physical activity program found reductions in cardiovascular risk among adults that live in lowincome communities in Rio de Janeiro City. 84 Another study from the Federal District found that the promotion of healthy eating habits and physical exercise by the FHS teams was associated with reductions in risk factors in overweight among adults. 85 Prioritizing disease prevention is also paramount in Turkey in order to address the rapid rise chronic diseases and modifiable risk factors such as rapidly rising obesity, particularly among women, and persistently high prevalence of smoking.…”