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To assess the reliability and validity of self-reported height and weight in adults living with HIV/AIDS (ALWHA) we assessed 508 ALWHA of both genders on antiretroviral therapy. Height and weight were directly measured in a subsample. Sensitivity and specificity analysis were performed to determine the validity of self-reported measures. Bland-Altman's method was used to calculate the limits of agreement between values while reliability was assessed using intraclass coefficients. Regression equations were devised to determine actual measures from self-reported values. Mean differences among measured and self-reported weight were -0.96 kg for men and -0.54 kg for women. Mean height differences were less than 2 cm, yielding good reliability for body mass index (BMI). Overweight (BMI >= 25 kg/m(2)) diagnosis sensitivity was 90.6% and specificity was 81.2%. Corrected measures determined by regression equations had stronger correlation with self-reported values (r > 0.980). Self-reported height and weight showed good reliability and validity compared with directly measured height and weight. However, measures should be corrected whenever possible to achieve higher accuracy. [ABSTRACT FROM AUTHOR]

Background: Insufficient physical activity, excessive screen time and short sleep duration among young children are global public health concerns; however, data on prevalence of meeting World Health Organisation 24-h movement behaviour guidelines for 3-4-year-old children in low- and middle-income countries (LMICs) are limited, and it is unknown whether urbanisation is related to young children's movement behaviours. The present study examined differences in prevalence of meeting 24-h movement behaviour guidelines among 3-4-year-old children living in urban versus rural settings in LMICs., Methods: The SUNRISE Study recruited 429, 3-4-year-old child/parent dyads from 10 LMICs. Children wore activPAL accelerometers continuously for at least 48 h to assess their physical activity and sleep duration. Screen time and time spent restrained were assessed via parent questionnaire. Differences in prevalence of meeting guidelines between urban- and rural-dwelling children were examined using chi-square tests., Results: Physical activity guidelines were met by 17% of children (14% urban vs. 18% rural), sleep guidelines by 57% (61% urban vs. 54% rural), screen time guidelines by 50% (50% urban vs. 50% rural), restrained guidelines by 84% (81% urban vs. 86% rural) and all guidelines combined by 4% (4% urban vs.4% rural). We found no significant differences in meeting the guidelines between urban and rural areas., Conclusions: Only a small proportion of children in both rural and urban settings met the WHO 24-h movement guidelines. Strategies to improve movement behaviours in LMICs should consider including both rural and urban settings., (© 2024 The Author(s). Child: Care, Health and Development published by John Wiley & Sons Ltd.)

Importance: The prevalence estimates of physical activity, sedentary behavior, and sleep (collectively known as movement behaviors) in 3- and 4-year-old children worldwide remains uncertain., Objective: To report the proportion of 3- and 4-year-old children who met the World Health Organization guidelines for physical activity, sedentary behavior, and sleep across 33 countries., Design, Setting, and Participants: Pooled analysis of data from 14 cross-sectional studies (July 2008 to September 2022) identified through systematic reviews and personal networks. Thirty-three countries of varying income levels across 6 geographical regions. Each study site needed to have at least 40 children aged 3.0 to 4.9 years with valid accelerometry and parent-/caregiver-reported screen time and sleep duration data. Data were analyzed from October 2022 to February 2023., Exposures: Time spent in physical activity was assessed by reanalyzing accelerometry data using a harmonized data-processing protocol. Screen time and sleep duration were proxy reported by parents or caregivers., Main Outcomes and Measures: The proportion of children who met the World Health Organization guidelines for physical activity (≥180 min/d of total physical activity and ≥60 min/d of moderate- to vigorous-intensity physical activity), screen time (≤1 h/d), and sleep duration (10-13 h/d) was estimated across countries and by World Bank income group and geographical region using meta-analysis., Results: Of the 7017 children (mean [SD] age, 4.1 [0.5] years; 3585 [51.1%] boys and 3432 [48.9%] girls) in this pooled analysis, 14.3% (95% CI, 9.7-20.7) met the overall guidelines for physical activity, screen time, and sleep duration. There was no clear pattern according to income group: the proportion meeting the guidelines was 16.6% (95% CI, 10.4-25.3) in low- and lower-middle-income countries, 11.9% (95% CI, 5.9-22.5) in upper-middle-income countries, and 14.4% (95% CI, 9.6-21.1) in high-income countries. The region with the highest proportion meeting the guidelines was Africa (23.9%; 95% CI, 11.6-43.0), while the lowest proportion was in North and South America (7.7%; 95% CI, 3.6-15.8)., Conclusions and Relevance: Most 3- and 4-year-old children in this pooled analysis did not meet the current World Health Organization guidelines for physical activity, sedentary behavior, and sleep. Priority must be given to understanding factors that influence these behaviors in this age group and to implementing contextually appropriate programs and policies proven to be effective in promoting healthy levels of movement behaviors.

This study aimed to investigate the association between sociodemographic and behavioral factors and obesity from 2014 to 2021 in adults in São Paulo city, Brazil. A prospective study was carried out with 1,241 adults aged 18 years or above who lived in São Paulo and participated in the São Paulo Health Survey cohort (ISA) - Physical Activity and Environment. The outcome was obesity (yes/no), classified by body mass index and specific cut-off points for each age group. The exposure variables included sex, age, education, skin color, marital status, regional health coordination, physical activity in the four domains, and sedentary behaviors. Multilevel logistic regression models were used for longitudinal analysis. This study found a significant increase (27.7%) in the prevalence of obesity (from 22.6% to 28.9%). People who practiced at least 150 minutes of leisure-time physical activity per week (OR = 0.44; 95%CI: 0.26; 0.76), between 10 and 150 minutes per week of commuting physical activity (OR = 0.49; 95%CI: 0.30; 0.80), and had no partner (OR = 0.47; 95%CI: 0.28; 0.78) were less likely to be obese. People aged from 40 to 59 years (OR = 5.00; 95%CI: 2.02; 12.38) and who were black (OR = 4.70; 95%CI: 1.85; 11.95) were more likely to be obese. This study found an increase in the prevalence of obesity during the studied period, with increased odds for middle-aged and black people and decreased odds for those without a partner and those who practice physical activities in their leisure and as a form of commuting. These results can contribute to support programs and policies to control obesity.

Background: There is limited evidence from globally diverse samples on the prevalence and correlates of meeting the global guideline of 180 minutes per day of total physical activity (TPA) among 3- to 4-year-olds., Methods: Cross-sectional study involving 797 (49.2% girls) 3- to 4-year-olds from 17 middle- and high-income countries who participated in the pilot phases 1 and 2 of the SUNRISE International Study of Movement Behaviours in the Early Years. Daily step count was measured using thigh-worn activPAL accelerometers. Children wore the accelerometers for at least one 24-hour period. Children were categorized as meeting the TPA guideline based on achieving ≥11,500 steps per day. Descriptive analyses were conducted to describe the proportion of meeting the TPA guideline for the overall sample and each of the sociodemographic variables, and 95% CIs were calculated. Multivariable logistic regression was used to determine the sociodemographic correlates of meeting the TPA guideline., Results: Mean daily step count was 10,295 steps per day (SD = 4084). Approximately one-third of the sample (30.9%, 95% CI, 27.6-34.2) met the TPA guideline. The proportion meeting the guideline was significantly lower among girls (adjusted OR [aOR] = 0.70, 95% CI, 0.51-0.96) and 4-year-olds (aOR = 0.50, 95% CI, 0.34-0.75) and higher among rural residents (aOR = 1.78, 95% CI, 1.27-2.49) and those from lower middle-income countries (aOR = 1.35, 95% CI, 0.89-2.04)., Conclusions: The findings suggest that a minority of children might meet the TPA guideline globally, and the risk of not meeting the guideline differed by sociodemographic indicators. These findings suggest the need for more surveillance of TPA in young children globally and, possibly, interventions to improve childhood health and development.

This study aimed to describe a quantitative survey conducted with leaders to investigate effective and feasible actions that can be evaluated in computational models to inform policies to promote active mobility based in the city of São Paulo, Brazil. In 2022, an online survey was conducted during the Health Survey in São Paulo (Physical Activity and Environment study), which is monitored by representatives of nongovernmental organizations and public and private sector managers. A questionnaire was elaborated with three questions with 13 alternative answers about actions to promote walking and/or cycling. Leaders should select up to three alternatives based on their potential regarding: (1) effectiveness; (2) feasibility or ease of implementation; and (3) desire to verify tests in computational models to inform policies. The survey was answered by 18 leaders from 16 institutions, comprising 13 (72%) women and 12 (67%) representatives of the third sector, whose average age was 48 years and all had complete higher education. Reducing the speed of motor vehicles was the most cited option in all three questions. Other actions mentioned refer to controlling the traffic of vehicles in central areas, improving pedestrian safety, reducing the distances between homes and places of employment, conducting educational campaigns, and expanding and enhancing structures such as bicycle lanes and sidewalks. The results are relevant to support evidence-based decision-making in public management and to provide subsidies for the development of computational models with a view to promoting active mobility.

Aim: To examine whether changes in public open spaces (POS) were associated with leisure-time walking (LTW) between 2014 and 2021., Methods: The sample comprised a prospective cohort of individuals living in São Paulo City, Brazil. The baseline sample was collected in 2014/2015 (4042 people aged 12 y or older) and the second wave in 2020/2021 (1431 people aged 18 y or older, 35.4% of total). Changes in POS scores in 500-m network buffers were based on household address, including positive or negative maintenance and increases or decreases in parks, public squares, and bike paths between 2015 and 2020. The International Physical Activity Questionnaire was used to evaluate LTW in the baseline and second wave. To examine the association of LTW with changes in POS, we used multilevel models in 4 levels: health administration areas, census tracts, individuals, and observations of individuals. The exposure was the POS tertiles, and the outcome was LTW., Results: Changes in LTW prevalence were observed in both periods and according to POS tertiles distributions. When adjusted for time (baseline/second wave), gender, education, and age, the highest POS tertile was significantly associated with a high likelihood for LTW (odds ratio = 1.44; 95% confidence interval, 1.03-2.02)., Conclusion: The results showed that people in São Paulo who lived within 500-m buffers with the highest access to POS were more likely to practice LTW between 2014/2015 and 2020/2021. These results have important implications for policies that were implemented in 2014, including the New Master Plan to contribute to São Paulo's good ranking among healthy cities.

Background: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries., Methods: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years., Results: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved., Conclusion: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.

Objectives: To validate parent-reported child habitual total physical activity against accelerometry and three existing step-count thresholds for classifying 3 h/day of total physical activity in pre-schoolers from 13 culturally and geographically diverse countries., Design: Cross-sectional validation study., Methods: We used data involving 3- and 4-year-olds from 13 middle- and high-income countries who participated in the SUNRISE study. We used Spearman's rank-order correlation, Bland-Altman plots, and Kappa statistics to validate parent-reported child habitual total physical activity against activPAL™-measured total physical activity over 3 days. Additionally, we used Receiver Operating Characteristic Area Under the Curve analysis to validate existing step-count thresholds (Gabel, Vale, and De Craemer) using step-counts derived from activPAL™., Results: Of the 352 pre-schoolers, 49.1 % were girls. There was a very weak but significant positive correlation and slight agreement between parent-reported total physical activity and accelerometer-measured total physical activity (r: 0.140; p = 0.009; Kappa: 0.030). Parents overestimated their child's total physical activity compared to accelerometry (mean bias: 69 min/day; standard deviation: 126; 95 % limits of agreement: -179, 316). Of the three step-count thresholds tested, the De Craemer threshold of 11,500 steps/day provided excellent classification of meeting the total physical activity guideline as measured by accelerometry (area under the ROC curve: 0.945; 95 % confidence interval: 0.928, 0.961; sensitivity: 100.0 %; specificity: 88.9 %)., Conclusions: Parent reports may have limited validity for assessing pre-schoolers' level of total physical activity. Step-counting is a promising alternative - low-cost global surveillance initiatives could potentially use pedometers for assessing compliance with the physical activity guideline in early childhood., Competing Interests: Declaration of interest statement None., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: There is a paucity of global data on sedentary behavior during early childhood. The purpose of this study was to examine how device-measured sedentary behavior in young children differed across geographically, economically, and sociodemographically diverse populations, in an international sample., Methods: This multinational, cross-sectional study included data from 1071 children 3-5 yr old from 19 countries, collected between 2018 and 2020 (pre-COVID). Sedentary behavior was measured for three consecutive days using activPAL accelerometers. Sedentary time, sedentary fragmentation, and seated transport duration were calculated. Linear mixed models were used to examine the differences in sedentary behavior variables between sex, country-level income groups, urban/rural settings, and population density., Results: Children spent 56% (7.4 h) of their waking time sedentary. The longest average bout duration was 81.1 ± 45.4 min, and an average of 61.1 ± 50.1 min·d-1 was spent in seated transport. Children from upper-middle-income and high-income countries spent a greater proportion of the day sedentary, accrued more sedentary bouts, had shorter breaks between sedentary bouts, and spent significantly more time in seated transport, compared with children from low-income and lower-middle-income countries. Sex and urban/rural residential setting were not associated with any outcomes. Higher population density was associated with several higher sedentary behavior measures., Conclusions: These data advance our understanding of young children's sedentary behavior patterns globally. Country income levels and population density appear to be stronger drivers of the observed differences, than sex or rural/urban residential setting., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Sports Medicine.)

City planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Content analysis identified strengths, limitations, and gaps in policies, allowing us to draw comparisons between cities. We found that despite common policy rhetoric endorsing healthy and sustainable cities, there was a paucity of measurable policy targets in place to achieve these aspirations. Some policies were inconsistent with public health evidence, which sets up barriers to achieving healthy and sustainable urban environments. There is an urgent need to build capacity for health-enhancing city planning policy and governance, particularly in low-income and middle-income countries., Competing Interests: Declaration of interests BG-C reports Senior Principal Research Fellowship (GNT1107672) and grant (number 1061404) support from National Health and Medical Research Council during the conduct of the study. CH was also supported by National Health and Medical Research Council through the Centre for Research Excellence in Healthy Liveable Communities (grant number 1061404). GB reports grants from the Public Good Projects, during the conduct of the study. JFS reports personal fees from Sports, Play, and Active Recreation for Kids (SPARK) physical activity programmes of Gopher Sport, and travel support from Rails to Trails Conservancy, outside the submitted work. JFS also has a copyright on SPARK physical activity programmes with royalties paid by Gopher Sport. DA was supported by an Impact Acceleration Award from the Economic and Social Research Council and funding from the Global Challenges Research Fund administered by the Department for the Economy, Northern Ireland, UK. SL was supported by the experiential fellowships from the College of Social Science and Humanities, Northeastern University, Boston, MA, USA. EC and JFS were supported by the Australian Catholic University, Melbourne, VIC, Australia. AAF is supported by a research fellowship from the Brazilian National Council for Scientific and Technological Development (CNPq) (#309301/2020-3). TB was supported by a Doctoral Scholarship from Auckland University of Technology, Auckland, New Zealand. AP-R was supported by the Centre for Health and Social Care Research at the University of Vic-Central University of Catalonia, Vic, Spain, and funding was provided by the Barcelona Provincial Council, Barcelona, Spain and City Council of Vic, Vic, Spain. CDGR is supported by the Portugal National Funds through Fundação para a Ciência e a Tecnologia, Instituto Público, Lisbon, Portugal, under the Research Fellowship (UI/BD/152231/2021). DS was supported by Washington University in St Louis, Center for Diabetes Translation Research, St Louis, MO, USA (P30DK092950 from National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health) and by the Cooperative Agreement Number U48DP006395 from the Centers for Disease Control and Prevention. RFH was supported by the UK Research and Innovation—National Health and Medical Research Council (project reference MR/T038934/1). The content of this article is solely the responsibility of the authors and does not represent the official views of any of the funding agencies supporting this work. Funding sources had no role in writing the manuscript or in the decision to submit for publication. All other authors report no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: BG-C and MS were supported by National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship funding (grant numbers: 1107672 and 1136250); BG-C and HB were also supported by RMIT Vice-Chancellor's Fellowships; CH was supported through an NHMRC Centre for Research Excellence in Healthy Liveable Communities (grant number: 1061404) and The Australian Prevention Partnership Centre (grant number: 9100003); DA was supported by an Impact Acceleration Award from the Economic and Social Research Council and funding from the Global Challenges Research Fund administered by the Department for the Economy, Northern Ireland, UK. EC's research was supported by the Australian Catholic University. APR was supported by the Centre for Health and Social Care Research of the University of Vic, Central University of Catalonia. The Barcelona Provincial Council and City Council of Vic provided funding for the Barcelona and Vic data collection. AAF was supported by a research fellowship from the Brazilian National Council for Scientific and Technological Development (grant number: 309301/2020-3). GB was supported by a grant from The Public Goods Projects. SL was supported by the experiential fellowships from College of Social Science and Humanities, Northeastern University. JFS was supported by Australian Catholic University. DS was supported by the Center for Diabetes Translation Research, Washington University in St Louis, MO, (grant number: P30DK092950 from National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK] at the National Institutes of Health [NIH]) and by the Centers for Disease Control and Prevention (CDC) (grant number: U48DP006395). MAA was supported by the National Cancer Institute at the NIH (grant number: R01CA198915). GV was supported by Ayudas para contratos Juan de la Cierva-formación 2019 (grant number: FJC2019-041233-I), and the Centro de Excelencia Severo Ochoa 2019–23 Program (grant number: CEX2018-000806-S) from the Spanish Government. RFH was supported by the UK Research and Innovation—National Health and Medical Research Council (grant number: MR/T038934/1). All other authors declare no competing interests. The content of this article is solely the responsibility of the authors and does not represent the official views of any of the NIDDK/NIH, CDC, or of any of the funding agencies supporting this work. We thank Karel Frömel, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic; David Vale, Lisbon School of Architecture, University of Lisbon, Lisbon, Portugal; Andreia Pizarro, Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, and Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal; Javier Molina-García, Department of Teaching of Musical, Visual and Corporal Expression, University of Valencia, Valencia, Spain; Hannah Hook, College of Health Solutions, Arizona State University, Phoenix, AZ, USA; Adetoyeje Y Oyeyemi, Department of Physiotherapy, University of Maiduguri, Maiduguri, Nigeria; Belinda Nemec, Melbourne; Judy Boyce, Healthy Liveable Cities Lab, Centre for Urban Research, RMIT University, Melbourne, VIC, Australia

Leisure-time physical activity (LTPA) is associated with access and use of public open spaces. The President João Goulart Elevated Avenue, currently denominated Minhocão, is a facility for leisure activities that is open for people during the night and weekends. The aim of this study was to examine if the prevalence of LTPA among individuals living in the surroundings of Minhocão is different according to proximity to, and use of, the facility. We conducted a cross-sectional study with cluster sampling with people aged ≥18 years who lived in households up to 500 m, and between 501 m and 1500 m of Minhocão. The survey was conducted between December 2017 and March 2019 using an electronic questionnaire. We conducted a bivariate analysis and Poisson regression to examine possible differences in LTPA according to the proximity of residences and use of Minhocão. The analysis used post-stratification weights. A total of 12,030 telephone numbers of people were drawn (≤500 m = 6942; and >500 m to ≤1500 m = 5088). The final sample included 235 residents who returned the questionnaires. There was a higher prevalence of individuals engaging in at least 150 min per week of LTPA among users than non-users (Prevalence Ratio = 2.19, IC95% 1.66 to 2.90), independently of sex, age, education, the distance of houses to nearest accesses and number of barriers. The main five barriers related to the usage of the Minhocão were safety issues in and around the Minhocão, rainy weather, lack of vegetation, and lack of facilities. People who used the park had higher prevalence of all types of LTPA than non-users. The results can serve to inform government decision-making on the future of Minhocão.

Background: This article describes the process and methods used in the development of the first ever Physical Activity Guidelines for the Brazilian Population., Methods: The steering committee established 8 working groups based on other guidelines and the Brazilian agenda for public health and physical activity (PA) promotion: (1) understanding PA; (2) children up to 5 years; (3) children and youth (6-17 y); (4) adults; (5) older adults (60 years and above); (6) physical education at school; (7) pregnant and postpartum women; and (8) people with disabilities. Working groups were formed to (1) synthesize the literature on each topic; (2) conduct workshops with stakeholders, health professionals, researchers, and the public; and (3) prepare a draft chapter for open online consultation., Results: The document provides guidance for the population on the benefits of being active and recommendations regarding the amount (frequency, intensity, and duration) of PA recommended across all chapters. It also includes information on supporting networks for PA., Conclusions: The PA guidelines are widely accessible in Portuguese, including versions in English, Spanish, audiobook, and Braille, and will assist policy makers and professionals from several sectors to promote PA. The ultimate goal is to increase population levels of PA in Brazil.

Background: This article presents the recommendations from the Physical Activity Guidelines for the Brazilian Population., Methods: A steering committee composed of a chair, 6 experts in physical activity, and representatives from the Ministry of Health/Brazil, Pan American Health Organization, Brazilian Society of Physical Activity and Health designed the guidelines, which was implemented by 8 working groups, as follows: (1) understanding physical activity, (2) children up to 5 years old, (3) children and youth from 6 to 17 years old, (4) adults, (5) older adults (60 years and above), (6) physical education at school, (7) pregnant and postpartum women, and (8) people with disabilities. The methodological steps included evidence syntheses, hearings with key stakeholders, and public consultation., Results: Across 8 chapters, the guidelines provide definitions of physical activity and sedentary behavior, informing target groups on types of physical activity, dosage (frequency, intensity, and duration), benefits, and supporting network for physical activity adoption. The guidelines are openly available in Portuguese, Spanish, English, and Braille and in audio versions, with a supplementary guide for health professionals and decision makers, and a report about the preparation and references., Conclusions: The Physical Activity Guidelines for the Brazilian Population provide evidence-based recommendations, being a public-directed resource to contribute to the physical activity promotion in Brazil.

Objective: To identify the strategies and effects of interventions carried out by community health workers (CHW) on physical activity (PA) levels in children and adolescents., Data Source: In August 2020, a systematic review, designed according to the PRISMA checklist items, was conducted by searches in seven electronic databases and in reference lists. Original studies were searched without restriction with regard to year of publication; they were written in Spanish, English or Portuguese and examined interventions implemented by CHW, involving theoretical and/or practical contents of PA, with a focus on children and/or adolescents between three and 19 years of age., Data Synthesis: Of the 2,321 studies initially retrieved, eight were included, targeting samples with more specific characteristics (e.g., clinical, ethnic and/or socioeconomic). In all studies, CHW were trained to lead educational activities. In three non-controlled trials, positive results were observed, involving indicators such as moderate and vigorous PA and physical inactivity reduction. Also, two positive results were found in reducing sedentary behavior., Conclusions: Even though most of the interventions included did not have a significant effect on increasing PA levels, the available findings reinforce the role of CHW as an important strategy for dialogue between health services and the most vulnerable communities, and they suggest a greater articulation of these professionals in the actions developed in the school context.

Introduction: 24-hour movement behaviours (physical activity, sedentary behaviour and sleep) during the early years are associated with health and developmental outcomes, prompting the WHO to develop Global guidelines for physical activity, sedentary behaviour and sleep for children under 5 years of age. Prevalence data on 24-hour movement behaviours is lacking, particularly in low-income and middle-income countries (LMICs). This paper describes the development of the SUNRISE International Study of Movement Behaviours in the Early Years protocol, designed to address this gap., Methods and Analysis: SUNRISE is the first international cross-sectional study that aims to determine the proportion of 3- and 4-year-old children who meet the WHO Global guidelines. The study will assess if proportions differ by gender, urban/rural location and/or socioeconomic status. Executive function, motor skills and adiposity will be assessed and potential correlates of 24-hour movement behaviours examined. Pilot research from 24 countries (14 LMICs) informed the study design and protocol. Data are collected locally by research staff from partnering institutions who are trained throughout the research process. Piloting of all measures to determine protocol acceptability and feasibility was interrupted by COVID-19 but is nearing completion. At the time of publication 41 countries are participating in the SUNRISE study., Ethics and Dissemination: The SUNRISE protocol has received ethics approved from the University of Wollongong, Australia, and in each country by the applicable ethics committees. Approval is also sought from any relevant government departments or organisations. The results will inform global efforts to prevent childhood obesity and ensure young children reach their health and developmental potential. Findings on the correlates of movement behaviours can guide future interventions to improve the movement behaviours in culturally specific ways. Study findings will be disseminated via publications, conference presentations and may contribute to the development of local guidelines and public health interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

We examined the association of physical activity (PA) facilities and access to school with total PA and domain-specific PA in adolescents. We enrolled 2610 adolescents (mean: 14.9 years) from Sao Paulo city. The number and presence of sports courts, swimming pools, locker rooms, running/athletics tracks, entrance accessible for student cyclists, bike racks, speed limit signal around the school, and pedestrian crossing were assessed in each school. All participants responded to a questionnaire about frequency and duration of physical education classes, leisure time, and active commuting. Total PA was obtained by adding up all PA domains. Presence of three or more (OR: 1.62; 95% CI: 1.15 to 2.30) sports courts, swimming pool available in usable conditions (OR: 1.45; 95% CI: 1.01 to 2.10), running/athletics tracks (OR: 2.35; 95% CI: 1.07 to 5.18), and bike racks (OR: 1.38; 95% CI: 1.07 to 1.78) were positively associated with total PA. Number of sports courts, swimming pool available in usable conditions, speed limit signals around the school, and pedestrian crossings were positively associated with physical education classes. The bike racks, speed limit signs around the school, and pedestrian crossings were positively associated with active commuting. School environment was associated with increased PA. Our findings should be considered in future epidemiologic studies and for educational and health policy makers., (© 2021. The Author(s).)

Objective: To evaluate the validity of self-reported body mass and height measurements in adolescents, adults and older adults according to sex, age, leisure-time physical activity level, nutritional status, and cardiometabolic risk factors., Methods: The study included 856 subjects, aged 12 years or older, who participated in the São Paulo Health Survey (ISA-2015) and who had their body mass and height measured and self-reported. Based on the Body Mass Index (BMI), a classification of nutritional status was made according to standardized criteria for each phase of life. The validation of self-reported data was examined by the Intraclass Correlation Coefficient, Bland-Altman and paired T-Test. Linear regression models were used to estimate the calibration coefficients, and sensitivity and specificity tests were performed., Results: Self-reported body mass and height values tend to be very similar to measured values, with a few exceptions. For the adolescents, an underestimation of height was noted, while for the older adults, an overestimation. There was a consistent underestimation of self-reported body mass among women, and an overestimation of BMI among men who practiced less than 150 minutes of physical activity per week during leisure time. The calibration process of self-reported measures made them more consistent with the values measured, increasing the sensitivity in the classification of nutritional status among women and the specificity among men., Conclusions: Self-reported measures of height, body mass and BMI provided valid and reliable measures, presenting a substantial improvement after calibration.

Given the potential of institutional approaches to health promotion, this study sought to identify the countries on the American continent which have national physical activity (PA) guidelines approved by their national health agencies. A scoping review was conducted in May 2019, with a search conducted in five electronic databases, national health agency websites and contacts with members of the Physical Activity Network of the Americas. In all, national PA guidelines were found in ten of the 36 countries surveyed (27.8%), published between 2011 and 2018, the majority being in South American countries (n = 6). All guidelines presented "approaches and strategies for primary health care," "PA recommendations for health," and the "involvement of different PA domains," however, few guidelines addressed "constructed environment and infrastructure" (n = 3), as well as "monitoring and surveillance actions" (n = 5). The conclusion can be drawn that, although few countries on the American continent have guidelines for PA and that the majority of those available address PA in a limited way, new national guidelines, based on the complexity of the determinants, monitoring and consequences of PA are needed to guide and foster policies to promote PA within the population.

Background: Managing HIV infection as a chronic condition includes encouraging adoption of healthy behaviors and promotion of physical activity (PA). However, people living with HIV (PLH) are often under social and programmatic vulnerability that may compromise behavior change. Understanding such barriers is crucial for successful incorporation of PA in their comprehensive care., Methods and Findings: In this study, we describe PA, energy intake from diet, and anthropometry of a cohort of PLH starting antiretroviral therapy (ART) at a Brazilian reference clinic, report how PA was addressed in routine care and investigate association between PA, energy intake and psychosocial constructs that may facilitate PA (social support and self-efficacy for PA). Among 61 PLH (86.9% males, mean age = 32.5 years) anthropometry was normal, but 47.5% reported PA below recommendations. Despite presenting high social support scores, family encouragement for PA was low, and self-efficacy classified as medium. Chart reviews yielded infrequent reports concerning PA. After adjusting for gender and age, we found a negative association between energy intake from diet and self-efficacy, but none between PA and energy intake or between PA and psychosocial constructs., Conclusions: We conclude that patients in our cohort were insufficiently active when starting ART, and that PA was poorly addressed by caretakers in routine HIV care. Nevertheless, social support and self-efficacy scores suggest potential for behavioral change. Caregivers should therefore start considering patients' vulnerabilities and establishing strategies to help them overcome barriers to incorporate PA in their comprehensive care effectively., Competing Interests: The authors have declared that no competing interests exist.

In 2011, the Brazilian Minister for Health created the Health Academy Program (Programa Academia da Saúde) as a strategy to promote health and healthy lifestyles. However, the official standards do not seem to be clear enough to support the implementation program in the towns. The aim of this study was to analyse the degree of Health Academy Program implementation in a Brazilian midsize town Vitória de Santo Antão, Pernambuco State, in 2018. This is an evaluative study that carry out a normative approach, considering the dimensions of structure and process related to work process. The research is divided into: (1) elaboration of the theoretical model of evaluation, through the validation of the logical model; (2) verification of the level of implementation, through an interview with workers and managers. The cut-off scores for classification of implementation levels were: (1) incipient: > 0 < 33.3%; (2) intermediate: > 33.3 < 66.6%; (3) advanced: > 66.6%. The level of implementation was considered intermediate (37.54%). The score of the structure was higher (54.76%) than the process (26.06%). The low level of Health Academy Program implementation, especially related to the multi-professional articulation and the difficult connection with other sectors or social actors, shows the necessity of reorganization of the actions.

The objective of this study was to verify whether residential density and connectivity between streets are mediators on the association between perceived environmental factors and active commuting to school (ACS) in Brazilian adolescents. This is a cross-sectional study with a random sample of 1,130 adolescents (52.7% girls) aged between 14 to 20 years, from Porto Alegre, Rio Grande do Sul State, Brazil. Adolescents' self-reported their usual mode of commuting to and from school using a questionnaire and the perceived environmental attributes by Neighborhood Environment Walkability Scale for Youth (NEWS-Y). Residential density and connectivity between streets were measured by gographic information systems (GIS), within 1km road network buffers around the participant's residential address. Regression models were fitted according to mediation analyses procedures. The results showed that residential density is a mediator on the association between ACS and perceived environmental factors, including land-use mix diversity (IE = 0.114; 95%CI: 0.130, 0.311; 32% mediation), neighborhood recreation facilities (IE = 0.064; 95%CI: 0.034, 0.105; 15% mediation), and access to services (IE = 0.045; 95%CI: 0.006, 0.104; 14% mediation). Connectivity between streets did not correlate with ACS, thus it was not tested in the mediation model. In conclusion, residential density is a mediator on the relationship between perceived environmental factors and ACS.

Objective: To analyze the prevalence of physical inactivity and the average time of practice of total physical activity and by domains (leisure and commuting), according to gender, age group and schooling, between 2003 and 2015, in residents of the urban area of the city of São Paulo., Methods: Data from Household Health Surveys in the Municipality of São Paulo (2003: n = 2,514; 2015: n = 4,043). The International Physical Activity Questionnaire was used to measure total, leisure, and commuting physical activity. Results were presented in < 10 minute/week periods, physical inactivity and minutes/week, according to evaluation period, sex, age and schooling., Results: Prevalence of < 10 minutes/week periods in 2003 and 2015 were: 22.5 and 28.9% for the total; 56.7 and 58.3% for leisure; and 35.2 and 39.9% for commuting, with significant change only in the total item, among adolescents (10.3 to 18.8%). For physical inactivity, prevalence rates were: 54.9 and 61.6% (total); 78.2 and 78.9% (leisure); and 72 and 79.9% (commuting), with significant changes only for commuting among adults (67.8 to 77.4%). For the average in minutes per week, in total, there was a significant decrease for female adolescents (138.2 minute/week) and adults with 0-8 (122.6 minutes/week) and 9-11 years (96.7 minutes/week) years of schooling; in commuting, there was a reduction for female adolescents (95 minutes/week); and male adults (95 minutes/week) and female adults (82 minutes/week)., Conclusions: There were no reductions in the prevalence of < 10 min/week periods or leisure physical inactivity. Commuting physical inactivity has become even more common.

Objectives: Comprehensive care for people living with human immunodeficiency virus (HIV) (PLH) includes the promotion of healthier habits, including physical activity (PA). This study aimed to describe a multicomponent pragmatic trial protocol to assess the effect of PA in preventing body changes and metabolic disturbances, improving the quality of life of PLH starting antiretroviral therapy (ART) and present cohort characteristics., Methods: PLH undergoing ART for ≤4 months were recruited for a randomized trial. The intervention comprised three cardiorespiratory and/or strength training sessions per week at the clinic or in public spaces for 6 months under on-site or remote supervision, and educational sessions. Participants' PA levels, cardiorespiratory fitness, anthropometric measures, strength, flexibility, quality of life, and laboratory monitoring (blood glucose and lipids, CD4 counts) at baseline and post-intervention will be compared. The pragmatic design aims to enable the assessment of intervention effectiveness in real-life conditions., Results: At baseline, our cohort of 38 recently diagnosed patients (mean time since HIV diagnosis and duration of ART were 3 and 2.58 months, respectively) were predominantly male, young, with high schooling and good immune status (median CD4 count=498 cells/mm3). Twenty-two (57.9%) patients reported a PA below the World Health Organization recommendations. We found baseline normal anthropometric measures and metabolic parameters: below-average trunk flexion and elbow extension strength, poor handgrip strength and flexibility, and high quality of life scores in all except the physical domain., Conclusions: Understanding how effective PA is in preventing body changes and metabolic disturbances, and in improving the quality of PLH starting ART may help establish guidelines to better incorporate PA in HIV care.

Background: Sedentary behavior is influenced by contextual, social, and individual factors, including the built environment. However, associations between the built environment and sitting time have not been extensively investigated in countries with economies in transition such as Brazil. The objective of this study is to examine the relationship between sitting-time and access to a mix of destinations for adults from Sao Paulo city, Brazil., Methods: This study uses data from the Health Survey of Sao Paulo. Sedentary behavior was assessed by a questionnaire using two questions: total sitting time in minutes on a usual weekday; and on a usual weekend day. The mix of destinations was measured by summing the number of facilities (comprising bus stops, train/subway stations, parks, squares, public recreation centres, bike paths, primary health care units, supermarkets, food stores, bakeries, and coffee-shops) within 500 m of each participant's residence. Minutes of sitting time in a typical weekday and weekend day were the outcomes and the mix of destinations score in 500 m buffers was the exposure variable. Associations between the mix of destinations and sitting time were examined using multilevel linear regression: these models accounted for clustering within census tracts and households and adjusted for environmental, sociodemographic, and health-related factors., Results: After adjustment for covariates, the mix of destinations was inversely associated with minutes of sitting time on a weekday (β=- 8.8, p=0.001) and weekend day (β=- 6.1, p=0.022). People who lived in areas with a greater mix of destinations had shorter average sitting times., Conclusion: Greater mix of destinations within 500 m of peoples' residences was inversely associated with sitting time on a typical weekday and weekend day. In Latin American cities like Sao Paulo built environments more favorable for walking may contribute to reducing sedentary behavior and prevent associated chronic disease.

Background: Many studies have investigated the association between the built environment and physical activity behavior in urban settings. However, most of the studies conducted in low- and middle-income countries were cross-sectional, which are limited to identify behavioral determinants. We propose a prospective cohort study to verify the relationship between built environment features and leisure-time and transport-related physical activity in adults from Sao Paulo city, Brazil., Methods: Prospective multilevel cohort, denominated "ISA-Physical Activity and Environment". It will build on the Health Survey of Sao Paulo in 2015 ("Inquérito de Saúde de São Paulo (ISA)" in Portuguese). The Health Survey of Sao Paulo, originally designed as a cross-sectional survey, had a multi-stage sample, covering 150 census tracts distributed in five health administrative areas. Data collection was performed by face-to-face interviews until December 2015 and the sample comprised 4043 individuals aged 12 years or more. The ISA-Physical Activity and Environment study will reassess people who are aged 18 years or more in 2020, including telephone and household interviews. The primary outcome will be leisure-time and transport-related physical activity, assessed through the International Physical Activity Questionnaire long version. Exposure variables will be built environment features in the areas participants live and work in the follow-up. Data analysis will include multivariate multilevel linear and logistic models. We will also conduct cost-effectiveness analysis and develop agent-based models to help inform decision-makers. The study will be conducted by an interdisciplinary research team specialized in physical activity epidemiology, nutritional epidemiology, georeferencing applied to health, statistics, agent-based modeling, public health policy, and health economics., Discussion: There are few longitudinal studies on the relationship between the built environment and physical activity behavior in low- and middle-income countries. We believe that the ISA-Physical Activity and Environment study will contribute with important results for the progress of the knowledge in this field and for the implementation of policies that promote leisure-time physical activity and active travel in Sao Paulo and similar cities across the world.

This study aimed to determine the prevalence and associated factors with physical activity counseling among Brazilian Family Health Strategy workers. This is a cross-sectional study conducted with a random sample of 591 health workers who work in the Family Health Teams of João Pessoa-PB, Brazil. Counseling for physical activity was defined as any advising targeted for increasing patients' physical activity levels conducted for at least six months. The following factors were considered: time working in health care units, amount of daily attendance, continuing education, perceived barriers, self-efficacy, attitude, self-rated health, physical activity level and nutritional status. Prevalence of counseling was 46.3%, being higher among physicians (74.5%; 95%CI: 59.6-85.2) and nurses (60.3%; 95%CI: 48.0-71.4) compared to community health workers (42.9%; 95%CI: 38.2-47.7) and nurses assistants (31.5%; 95%CI: 20.2-45.4). The results showed health professionals with positive self-rated health, without perception of barriers, having a positive attitude and high self-efficacy were more likely to perform physical activity counseling. Knowledge and actions on factors associated with physical activity counseling can help broaden the involvement of primary health care providers in health education.

This study investigated relationships between state anxiety and leisure-domain physical activity levels during Covid-19 pandemic. We used frequency, duration, and intensity as key variables of physical activity. Trait anxiety, state anxiety before pandemic, age, gender, and education level were also included in the analysis. Our general hypothesis was that participants who declared doing more physical activity levels would exhibit lower levels of anxiety during the Covid-19 pandemic. A convenient sample of 571 volunteer adults (mean age 39 ± 14 years) was drawn mainly from São Paulo State (89.2% of the sample), the epicenter of Covid-19 pandemic in Brazil. To obtain the participants' levels of anxiety (trait, state before pandemic, and state during pandemic) we used a validated short-version of the State and Trait Anxiety Inventory . Levels of physical activity were measured via questions from VIGITEL, a validated questionnaire about the individual's habits on risk factors. Answers were given regarding the first week of March 2020 (before pandemic) and at the very moment the participant was filling in the electronic form (June 2020). Data analyses were conducted through descriptive and inferential techniques, with the use of non-parametric tests and linear regression models. Overall, participants' responses indicate that anxiety levels were higher during the pandemic compared to the period that preceded the pandemic, and that frequent and long physical activity in the leisure-domain reduced anxiety, regardless its intensity. The regression models revealed an inverse relationship between physical activity and anxiety (the more physical activity, the less anxiety) and independent of gender, age, education level, trait anxiety, and physical activity before pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor declared a shared affiliation, though no other collaboration, with the authors., (Copyright © 2020 Meira, Meneguelli, Leopoldo and Florindo.)

Objective: To investigate the temporal trend of practicing physical exercise and sports during leisure time in adults in São Paulo between 2006 to 2016., Methods: Time series analysis study using the VIGITEL System. Adding up the number of people who participated each year, a total 21,357 people were studied. Analyzes of the physical exercises and sports practiced during leisure time (yes or no) stratified by sex, age and education were performed. The prevalences and the differences for all of the years were calculated using the Prains-Winster regression., Results: Practice of physical exercises or sports increased by 7.9 percentage points in the period (p = 0.003) (from 39.9% 95%CI 37.4 - 42.4 to 47.8% 95%CI 45.2 - 50.4). There was a significant increase for women (p = 0.011), for people between 18-24 years old (p = 0.001), 25-34 years old (p = 0.003), 45-54 years old (p = 0.003), and for people with up to eight years of schooling (p = 0.010). There was a decrease in walking and playing soccer and there was an increase in doing gymnastics., Conclusion: There was an increase in the practice of physical exercise and sports during leisure time in adults from São Paulo. These increases were observed mainly in women, in people between 18 and 34 years old, between 45 and 54 years old, and in people with up to eight years of schooling. These results are important, as they have shown an increase in general and in more vulnerable groups, and may be related to environmental changes and interventions that have occurred in the city in the last 15 years.

Objectives: We examined the patterns of total and domain-specific physical activity (PA) by sex, socioeconomic status and maternal education level in adolescents from Sao Paulo city, Brazil., Design: Cross-sectional study., Participants: We included a representative sample of 2682 (52.2% boys) adolescents aged 14-15 years from public and private schools in Sao Paulo, 2017. Socioeconomic status was assessed using a wealth index derived from principal component analysis. Descriptive analyses evaluated differences in total and domain-specific PA by sex, socioeconomic status and maternal education level., Outcome Measures: We collected data on the frequency and duration that adolescents spent in each PA domain (active transportation, leisure PA and physical education classes) through a self-report questionnaire., Results: On average, adolescents spent 197.7 min/week (95% CI 190.6-204.8) in total PA. The proportion of adolescents achieving at least 60 min/day (≥420 min/week) was 12.7% (95% CI 11.4-14.1), with a higher prevalence in boys (18.3%) and in those with higher socioeconomic status (17.4%). Similar patterns were observed for leisure PA and physical education classes. Active transportation was higher in girls (46.0 min/week; 95% CI 42.6-49.6) than in boys (43.4 min/week, 95% CI 39.9-46.6). Boys and adolescents with higher socioeconomic status and higher maternal education level had higher levels of total PA., Conclusions: We found a variation in patterns of total and domain-specific PA by sex, socioeconomic status and maternal education level in adolescents from Sao Paulo. Initiatives for promoting PA in adolescents should take these findings into account., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The obesogenic environment stimulates an inadequate diet by hampering healthy choices. This cross-sectional study evaluated the association between the local food environment and the prevalence of overweight and obesity in a representative sample population of adolescents living in the city of São Paulo, Brazil, using multilevel logistic regression models. Among the adolescents, 29.6% were overweight/obese. There were no significant differences between food environment and adolescents' weight status. However, the presence of fast food restaurants near their home increased the chances of being overweight or obese (OR = 2.53; 95%CI: 1.02-6.27). Results suggest the need to intensify food and nutrition policies, development of culinary skills, and the reduction in prices of healthy foods to facilitate access to these foods, so that adolescents have options in locations to socialize with friends and family.

OBJECTIVE To identify and evaluate the effects of community-based interventions on the sedentary behavior (SB) of Latin American children and adolescents. METHODS A systematic review on community-based trials to reduce and/or control SB in Latin American countries (Prospero: CRD42017072157). Five databases (PubMed, Web of Science, Scopus, SciELO and Lilacs) and a reference lists were searched. RESULTS Ten intervention studies met the eligibility criteria and composed the descriptive synthesis. These studies were conducted in Brazil (n=5), Mexico (n=3), Ecuador (n=1) and Colombia (n=1). Most interventions were implemented in schools (n=8) by educational components, such as meetings, lessons, and seminars, on health-related subjects (n=6). Only two studies adopted specific strategies to reduce/control SB; others focused on increasing physical activity and/or improving diet. Only one study used an accelerometer to measure SB. Seven studies investigated recreational screen time. Eight studies showed statistically significant effects on SB reduction (80%). CONCLUSIONS Latin America community-based interventions reduced children and adolescents' SB. Further studies should: define SB as a primary outcome and implement strategies to reduce such behaviour; focus in different SBs and settings, other than recreational screen time or at-home sitting time; and use objective tools together with questionnaires to measure sedentary behaviour in.

Objective: To summarize indicators and describe in detail the methods used to physical activity and sedentary behavior measurement in South American preschool children., Data Source: In 2017, we searched for articles on researches carried out in South American countries, which presented physical activity and/or sedentary behavior indicators in children aged two to six years. These searches were conducted in Spanish, English, and Portuguese in four electronic databases (LILACS, PubMed, SciELO, and Web of Science), Google Scholar, and in reference lists., Data Summary: Out of 416 articles initially assessed, 13 composed the descriptive summary. Samples from Argentina, Brazil, and Chile were included. Three articles provided accelerometer-based estimates of moderate physical activity: 32, 70.1, and 71.3 minutes per day. The mean total sedentary behavior was 468.3 and 562.9 minutes per day and, considering the cut-off point of 2 hours per day of screen time, we found the following prevalence rates: 39.4, 40.3, and 100%. The studies adopted a wide number of instruments and strategies to evaluate those behaviors., Conclusions: Although the summary has pointed to high exposure to sedentary behavior in preschool children, with particular focus on screen time, it is essential to broaden the discussion and approximate the methods used to assess physical activity and sedentary behavior, making the evidence more comparable and strong, so as to elaborate preventive strategies and actions.

The article sought to describe awareness of public physical activity programs, practice of physical activity in public programs and barriers related to non-participation in these programs in a national representative sample according to sex, age, skin color, income, state and having been visited by a family health team (EqSF, in Portuguese) in the previous year. This is a cross-sectional survey with data from the Brazilian National Health Survey, 2013. We carried out descriptive analyses using the distribution of relative frequencies and their respective 95% confidence intervals, weighted in the sample design. We included 60,202 individuals. We found a 20% prevalence of awareness and, of these, 9.7% reported practicing physical activity in public programs. Most commonly reported barriers were lack of time (41.4%) and lack of interest in available activities (29.7%). Women have greater awareness when compared with men, but levels of physical activity were similar in both sexes. Awareness and physical activity were higher in the older age groups. Awareness increased with income, but the poorest participate more in public physical activity programs when compared with the other income categories. Awareness and physical activity were similar among those who were and were not visited by EqSF. Prevalences of awareness and participation in public physical activity programs are not expressive, with nearly 30% of individuals disinterested in current programs. Local-regional efforts are needed so that physical activity can be established as a health promotion tool.

Introduction: Most interventions aiming to promote leisure-time physical activity (LTPA) at population level showed small or null effects. Approaching the problem from a systems science perspective may shed light on the reasons for these results. We developed an agent-based model to explore how the interactions between psychological attributes and built and social environments may lead to the emergence and evolution of LTPA patterns among adults., Methods: The modeling process consisted of four stages: (1) conceptual model development, (2) formulation of the agent-based model, (3) parametrization and calibration, and (4) consistency and sensitivity analyses. The model represents a stylized community containing two types of agents: persons and LTPA sites. Persons interact with each other (proximal network and perceived community) and with the built environment (LTPA sites) over time. Decision-making is based on the person's intention to practice LTPA, conditioned to the perceived environment. Each iteration is equivalent to one week and we assessed a period of 10 years., Results: The model was able to reproduce population temporal trends of intention and LTPA reported in the literature. Sensitivity analyses indicated that population patterns and trends of intention and LTPA were highly influenced by the relationship between a person's behavior in the preceding week and his current intention, the person's access to built and social environment, and the density of LTPA sites., Conclusions: The proposed agent-based model is suitable to explore the emergence and evolution of LTPA patterns among adults, considering the dynamic interaction between individuals' psychological attributes and the built and social environments in which they live. The model is available at https://doi.org/10.17605/OSF.IO/J2KAS .

Little is known about the association between environmental characteristics and types of physical activity in adolescents in a Latin American context. The aim of this study was to examine the association between perceived neighborhood environmental characteristics and different types of physical activity in 2,874 adolescents from Joao Pessoa, Paraiba State, Northeastern Brazil. The types of activity measured by questionnaire (≥10 min/day) included sports, physical exercises, active commuting and recreational activities. Neighborhood characteristics were measured by a 15-item scale. Multilevel analyses showed that adolescents who reported "having places they liked to go to" (OR = 1.41; 95%CI: 1.10-1.79) and "places with opportunities to practice" (OR = 1.29; 95%CI: 1.01-1.65) were more likely to play sports. "Seeing interesting things while walking" (OR = 1.24; 95%CI: 1.01-1.53) and "Seeing other adolescents engaged in physical activity" (OR = 1.47; 95%CI: 1,05-2,06) were associated with exercises. "Seeing other adolescents engaged in physical activity" (OR = 1.47; 95%CI: 1.18-1.82), "the neighborhood is not violent" (OR = 1.29; 95%CI: 1.04-1.60) and "having places they like to go to" (OR = 1.59; 95%CI: 1.13-2.25) were positively associated and "places with opportunities to practice" (OR = 0.79; 95%CI: 0.63-0.98) inversely related to active commuting. "Seeing other adolescents engaged in physical activities" (OR = 1.31; 95%CI: 1.05-1.63) and "seeing interesting things while walking" (OR = 1.26; 95%CI: 1.02-1.56) were associated with recreational activities. Neighborhood environmental characteristics associated with the physical activity vary with the type of practices adopted by adolescents.

Cities that support cycling for transportation reap many public health benefits. However, the prevalence of this mode of transportation is low in Latin American countries and the association with facilities such as bike paths and train/subway stations have not been clarified. We conducted a cross-sectional analysis of the relationship between bike paths, train/subway stations and cycling for transportation in adults from the city of Sao Paulo. We used data from the Sao Paulo Health Survey ( n = 3145). Cycling for transportation was evaluated by a questionnaire and bike paths and train/subway stations were geocoded using the geographic coordinates of the adults' residential addresses in 1500-m buffers. We used multilevel logistic regression, taking account of clustering by census tract and households. The prevalence of cycling for transportation was low (5.1%), and was more prevalent in males, singles, those active in leisure time, and in people with bicycle ownership in their family. Cycling for transportation was associated with bike paths up to a distance of 500 m from residences (OR (Odds Ratio) = 2.54, 95% CI (Confidence interval) 1.16-5.54) and with the presence of train/subway stations for distances >500 m from residences (OR = 2.07, 95% CI 1.10-3.86). These results are important to support policies to improve cycling for transportation in megacities such as Sao Paulo., Competing Interests: All authors declare no conflict of interest.