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Background: Guidelines recommend that adolescents should accumulate an average of 60 min per day of moderate-to-vigorous physical activity (MVPA). However, using only this cut-off could hide important information. For instance, from a population-level point of view, increasing physical activity for those with no or low physical activity could provide more health benefits than increasing physical activity for those with intermediate levels. Also, including a more sensitive cut-point of ≥1 days per week could be an additional strategy for identifying those with low access/opportunities for physical activity practice. Thus, the current study aims to estimate the prevalence of ≥60 min of MVPA ≥1 days per week among adolescents globally, and to describe any relevant gender inequalities., Methods: We used representative datasets from 146 countries/territories collected between 2003 and 2019. MVPA was self-reported. Participants were grouped into younger (≤14 years old) and older (>14 years old) adolescents. Crude Poisson regression models were used to identify the relative differences in ≥60 min of MVPA ≥1 days per week between boys and girls, and random-effects meta-analysis models were used to identify the pooled estimates. Analyses were stratified by country and region., Results: Approximately 80% of both younger and older adolescents reported ≥60 min of MVPA ≥1 days per week. This prevalence was ≥94% in Europe and Central Asia and North America, while the estimates for the other regions were <77%. The prevalence of ≥60 min of MVPA ≥1 days per week was higher among boys than girls, with the largest differences occurring among the oldest adolescents (Prevalence ratio ≤14y = 1.04 (95% confidence interval (95%CI)): 1.03‒1.04) vs. Prevalence ratio >14y = 1.09 (95%CI: 1.08‒1.10))., Conclusion: Approximately 8 out of 10 adolescents reported accumulating ≥60 min of MVPA ≥1 days per week, with notable differences between regions. Gender differences were observed in several countries, especially among the oldest adolescents. Priorities for physical activity promotion among adolescents should include increasing access/opportunities for physical activity among those who do not achieve ≥60 min of MVPA ≥1 days per week and reducing gender inequalities., (Copyright © 2024. Production and hosting by Elsevier B.V.)

Physical activity (PA), sedentary behavior (SB), and sleep duration are known to have an individual effect on clinic blood pressure (BP) of older adults. However, whether different patterns of these so-called movement behaviors over the 24h-cycle on BP remains poorly investigated. The study aimed to identify movement behavior patterns associated with clinic BP among older adults with chronic diseases. Cross-sectional study with 238 older adults (80.3% female; mean age 68.8 ± 6.6) with at least one chronic disease. PA, SB, and sleep duration were measured by a triaxial accelerometer. Clinic systolic BP (SBP) and diastolic BP (DBP) were obtained through an automated method following standard procedures. Non-hierarchical K-means cluster and linear regression modeling were employed to identify the clusters of movement behaviors and to examine the associations. Two clusters were identified [active and non-sedentary, n = 103 (i.e., sufficient sleep duration, higher LPA and MVPA, and lower SB) and sedentary and inactive, n = 135 (i.e., sufficient sleep duration, lower LPA and MVPA, and higher SB). Active and non-sedentary older adults presented lower systolic BP compared to sedentary and inactive ones, even after adjustments for sociodemographic and clinical characteristics (β = 6.356; CI 95% from 0.932 to 11.779; P = 0.022). No associations were found for diastolic BP. In conclusion, higher PA and lower SB were associated with lower systolic BP in older adults with chronic diseases. However, sleep duration did not modify this association. Therefore, interventions focusing on concomitantly increasing PA levels and reducing SB should be the priority for controlling blood pressure., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Preschools may provide opportunities for children to engage in physical activity (PA), to benefit their health, although little is known when concerning low-income preschoolers. This study aimed (1) to describe time spent in PA among low-income children during preschool hours and (2) to analyse how many children meet the PA recommendations during preschool hours., Methods: A total of 204 low-income preschoolers (4.51 ± 0.79 years) from João Pessoa/Brazil provided valid accelerometer (Actigraph, WGT3-X) data during the preschool period. Children were grouped in quartiles of PA in counts per minute, according to sex and age. The General Linear Model Univariate was used to examine the differences in PA intensities between the quartiles and the time spent in total PA (TPA) and moderate-to-vigorous PA (MVPA) by quartiles, according to age. An hour-by-hour description of children's PA was presented., Results: TPA during preschool hours ranged from 68.33% to 113.89% of the recommended and from 28.34% to 81.68% of the MVPA recommendations. Among 5-year-old children, those in the highest quartile met the PA recommendations. All children were more active outdoors than indoors. For the less actives, preschool time corresponded to 30% of the recommended daily MVPA., Conclusion: The current results reinforce the importance of preschool settings for promoting preschoolers' PA and provide particularly important and useful information for tailoring preschool-based interventions focused on those who need it most. Strategies to increase children's MVPA should be prioritized during free-play time., (© 2024 John Wiley & Sons Ltd.)

Background: Undergraduate students present high rates of psychological distress, including suicide risk. Due to the coronavirus disease 2019 (COVID-19) pandemic, this scenario may have been aggravated. Thus, the objective of the current study was to evaluate changes in the suicide risk rate from the period before to during the COVID-19 pandemic, as well as the factors associated with this outcome among Brazilian undergraduate students., Methods: This was a nationwide survey carried out in Brazil with a cross-sectional design, including two data collection periods: a single-center in-person collection in 2019 and another multicenter online collection in 2020/2021. Data were collected using self-administered instruments. The outcome was a high risk of suicide, measured through the Mini International Neuropsychiatric Interview. Analyses were carried out on data from two periods, i.e. before and during the pandemic (bivariate analysis and interaction tests), and a model of associated factors (multivariate analysis using Poisson regression) was developed including all participating universities distributed in the five regions of Brazil., Results: In total, 6716 Brazilian undergraduate students participated (996 in 2019 and 5720 in 2020/2021). The prevalence of a high suicide risk rose from 11.3% to 17.0%, especially among women and poorer individuals. The prevalence of a high risk of suicide among Brazilian undergraduates was 19.6% and was associated with several socioeconomic, academic, pandemic, and mental health factors., Conclusions: The prevalence of a high suicide risk increased from prepandemic to during the pandemic, appearing to be largely influenced by social determinants, in conjunction with the implications of the COVID-19 pandemic.

This study examined the prevalence and sociodemographic correlates of meeting individual behavior and 24-hr movement behavior guidelines among Brazilian older adults with chronic diseases. The sample comprised 273 older adults aged ≥60 years (80.2% women) with chronic diseases from Recife, Pernambuco, Brazil. Sociodemographic variables were self-reported, while 24-hr movement behaviors were assessed by accelerometry. Participants were classified as meeting (or not meeting) individual and integrated recommendations for moderate-to-vigorous physical activity (MVPA), sedentary behavior, and sleep duration. No participant met the 24-hr movement behavior guidelines, while only 8.4% met integrated MVPA/sleep recommendations. The prevalence of meeting recommendations of MVPA, sedentary behavior, and sleep was 28.9%, 0.4%, and 32.6%, respectively. Discrepancies according to sociodemographic variables on meeting MVPA recommendations existed. The findings show the need for dissemination and implementation strategies to foster adoption of the 24-hr movement behavior guidelines among Brazilian older adults with chronic diseases.

Introduction: The academic environment can negatively impact the mental health of undergraduate students, particularly in the context of the coronavirus disease 2019 (Covid-19) pandemic. This study aimed to describe the methodological and operational aspects of a study of the health and well-being of undergraduate students: the Study on the Health and Wellness of Undergraduate Students (SABES-Grad) project., Method: This was a nationwide cross-sectional study divided across two data collection strategies: a single-center, on-site data collection carried out in 2019 at the Universidade Federal do Rio Grande (FURG) and a multicenter, multilevel, online data collection carried out in 2020/2021 at FURG, the Universidade Federal Fluminense (UFF), the Universidade Federal do Mato Grosso (UFMT), the Universidade do Estado do Amazonas (UEA), and the Universidade Federal Rural de Pernambuco (UFRPE). The main outcomes of interest were depressive symptoms, generalized anxiety, and suicide risk., Results: A total of 996 students participated in the 2019 data collection (63.8% female; median age of 22 years; response rate of 85.2%) and 5,720 students participated in the 2020/2021 collection (66.7% female; median age of 22 years; response rate of 84.3%). Significant variations in socioeconomic and demographic profiles were observed between the different universities. Approximately one-third of the sample had been tested for Covid-19 in 2020/2021, 7.8% of whom had tested positive., Conclusion: The SABES-Grad project was the result of collaborative work between several actors from public universities in Brazil. Several aspects of the preparation and execution of this research are discussed in terms of its originality and relevance. Barriers and limitations and strategies adopted to overcome them are also presented., Competing Interests: No conflicts of interest declared concerning the publication of this article.

Background: To identify the prevalence and sociodemographic correlates of different domains of physical activity (PA) and higher sitting time among South American adolescents., Methods: Data from national surveys of 11 South American countries were analyzed, and comprised information on 166,901 adolescents. PA (≥ 60 min/day of moderate-vigorous PA), physical education classes (PEC) (≥ 3 classes/wk), active commuting to school (≥ 1 d/wk), and higher sitting time (≥ 3 h/d) were self-reported. Sociodemographic correlates, such as gender, age, and food security status were explored using a random effect meta-analysis for logistic parameters., Results: Recommended PA ranged between 7.5% (Brazil) and 19.0% (Suriname). Peru (2.2%) and Guyana (43.1%) presented the lowest prevalence of PEC and active commuting to school, respectively. Higher sitting time was less prevalent in Bolivia (24.6%) and more prevalent in Argentina (55.6%). Compared to girls, boys were more prone to reach recommendations for PA [OR = 1.94(1.65;2.28)]; to reach ≥ 3 PEC [OR = 1.17(1.04;1.33)] and to be active in commuting to school [(OR = 1.14(1.06;1.23)], but less prone to higher sitting time [OR = 0.89(0.82;0.96)]. Older adolescents had less odds of reach PA guidelines [OR = 0.86(0.77; 0.97)] and accumulated higher sitting time [OR = 1.27(1.14;1.41)]. Adolescents with food insecurity reported more PEC [OR = 1.12(1.04;1.21)] and active commuting to school [OR = 1.12(1.02;1.22)] but had less higher sitting time than their food security pairs [OR = 0.89(0.81;0.98)]., Conclusions: Few adolescents reach the PA recommendation. Actions aiming the promotion of PA and the reduction of sitting time must consider girls and older adolescents as target groups, as well as the specifics of each country., (© 2022. The Author(s).)

Objective: This study had the purpose investigate the physical activity (PA) and sedentary time profile of children with cerebral palsy and its association with body composition., Methods: A cross-sectional study evaluated 53 children, between 2 and 10 years old, enrolled in three health services Recife-city, northeast of Brazil. Sedentary and PA were measured for a week using the ActiGraph GTX3 accelerometer. Body composition was assessed by anthropometry and an electrical bioimpedance device., Results: Time on PA was one hour longer among the mild/moderate CP compared to severe ones, but, sedentary time is similar. Dyskinetic children spent more time in PA, but also in sedentary activities (15.5 hours a day) than spastic ones (12.8). Stunting occurred in 15 (30%) of the sample, all children with stunting had severe impairment. Underweight occurred in 25% of the severe group and 11.8% in the mild/moderate group. Overweight affected 3% of the sample; no overweight children were in the severe group. Body fat% was inversely related to time spent in moderate to vigorous PA., Conclusions: Children with CP spend more than a half of their daily time in sedentary activity. In contrast, children with mild to moderate CP spent twice as much time in moderate to vigorous PA and had a tendency (p = 0.07) to spend 50% more time in light PA. Moreover, time spent on moderate to vigorous activity was inversely related to fat mass., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2021. Published by Elsevier Editora Ltda.)

Background: Accruing adequate daily amounts of time spent on movement behaviors (physical activity (PA), sedentary behavior (SB), and sleep) in childhood has been associated with positive short and long-term health outcomes. Nonetheless, how waking time is distributed across PA and SB among preschoolers who are short and adequate sleepers at night is unknown., Aim: This study investigated: (1) if there are differences in a movement behaviors composition among adequate and short nocturnal sleepers; and (2) the association between preschoolers' time spent in PA, SB, and sleep among adequate and short nocturnal sleepers., Methods: A total of 270 preschoolers (132 boys; 3.97 ± 0.81 years old; 15.48 ± 1.62 kg/m 2 ) participated in this study. PA and SB were assessed using accelerometry (model wGT3X). Sleep duration was assessed through a parental-proxy interview, and preschoolers were stratified as short and adequate sleepers, according to attendance to international sleep duration guidelines. Compositional data analysis was used to explore the time-use patterns of behaviors among adequate and short sleepers., Results: Short sleepers spent 64 min less time asleep, accumulated 32 min in more sedentary time (p = .005, Cohen's d = 0.36, Bayes Factor: 6.17), and 24 min more in light PA (p = .0005, Cohen's d = 0.44, Bayes Factor: 46.37) compared to adequate sleepers., Conclusions: Being a short sleeper was associated with greater time spent in SB and light PA during their waking hours. The health implications of movement behaviors composition among short sleep preschoolers should be further investigated., (© 2021 Wiley Periodicals LLC.)

Background: Evidence from a limited sample of countries indicates that time for physical education and recess during school have declined. Schools are called to provide children with 30 minutes of moderate to vigorous physical activity (MVPA). This systematic review and meta-analysis estimated temporal trends in children's school day MVPA., Methods: Three online databases were searched to identify studies with objectively measured MVPA, during school hours, in school aged children (5-18 y). Multilevel random-effects meta-analyses estimated MVPA by year, and meta-regression analyses estimated temporal trends in school day MVPA., Results: Studies (N = 65) providing 171 MVPA estimates, representing 60,779 unique children, from 32 countries, and spanning 2003-2019 were identified. Most studies were conducted in North America (n = 33) or Europe (n = 21). School day MVPA ranged from 18.1 (95% confidence interval, 15.1-21.1) to 47.1 (95% confidence interval, 39.4-54.8) minutes per day in any given year. Meta-regression analyses indicated that MVPA declined from 2003 to 2010 (approximately 15 min decline), plateaued from 2010 to 2015 (approximately 1 min decrease), and increased from 2015 to 2019 (approximately 5 min increase)., Conclusions: School day MVPA decreased from 2003 to 2010 and has recently begun to increase. However, the majority of the evidence is from North America and Europe with some evidence from Oceania and very little evidence from Asia to South America.

This study identifies physical activity (PA) and sedentary behaviour (SB) clusters in preschoolers compliant (C) or non-compliant (NC) with sleep recommendations; and associates these clusters with obesity markers. PA and SB were objectively assessed (Actigraph WGT3-X) in 272 preschoolers (4.4 ± 0.7 years old). Sleep duration was parent-reported, and preschoolers were classified as C (3-4 years old: 600-780 min/day; 5 years old: 540-660 min/day) or NC with sleep recommendations. Body mass index (BMI) and waist circumference (WC) were assessed according to international protocols. Moderate to vigorous physical activity (MVPA) and light physical activity (LPA) were categorized as low/high (<60 min/>60 min/day or <180 min/180 min/day, respectively). SB was defined according to mean values between clusters. Latent profile analysis was performed. Associations between the observed clusters and obesity markers were determined using linear regression (RStudio; 1.3.1073). Four cluster solutions for C and NC preschoolers were identified. A negative association between C/Low MVPA cluster and BMI, and a positive association between NC/Low MVPA and BMI (β = -0.8, 95%CI = -1.6;-0.1, and β = 0.9, 95%CI = 0.1;1.7, respectively) were observed. No association was seen for SB clusters. Adequate sleep duration may have a protective role for preschoolers' BMI, even if the children do not comply with MVPA recommendations.

Little is known of how reallocations of time spent in different movement behaviors during preschool might relate to preschoolers' fundamental movement skills (FMS), a key predictor of later physical activity (PA). Thus, the aim of this study was to examine (a) whether preschoolers' school-time movement was associated with their FMS and (b) the effects on FMS of reallocating time between PA and sedentary behavior (SB). This was a cross-sectional study, using intervention data with Brazilian low-income preschoolers. We observed Brazilian preschoolers of both sexes ( M age  = 4.5, SD  = 0.8 years-old; 101boys) over 10 hours of school-time and objectively assessed their PA and SB with Actigraph wGT3X and their FMS with the Test of Gross Motor Development - Second Edition. We explored the associations between school-time movement behaviors and FMS and between reallocated school-time movement behaviors and FES using compositional analysis in R (version 1.40-1), robCompositions (version 0.92-7), and lmtest (version 0.9-35) packages. This isotemporal reallocation showed that, for manipulative skills, reallocating time (5, 10, and 15 minutes, respectively) from light PA to SB was associated with increasing skill (0.14, 0.28, and 0.42 FMS units), raising questions as to whether fine motor activity occurred during SB. Thus, school-time movement significantly predicted FMS, with a modest increase in SB, at the expense of light PA eliciting improved manipulative skills.

Background: The importance of movement behaviors for health is well known, although few studies have examined the adherence to movement guidelines in low-income preschoolers from a middle-income country, as Brazil. This study reports the proportion of preschoolers meeting the 24-hour movement guidelines and investigates its associations with demographic correlates in Brazilian low-income preschoolers., Methods: Two hundred and seventy preschoolers (132 boys, means age = 3.97 ± 0.80) provided physical activity (PA) data (Actigraph wGT3X). Sleep duration, screen time, and social correlates were parent-reported. Preschoolers were classified as compliant/not compliant with the 24-hour movement guidelines. Relationships between compliance with movement behaviors guidelines and demographic correlates were calculated using a network analysis (Mplus 8.0; Rstudio)., Results: Preschoolers were active (273.52 ± 62.08 minutes/day of total PA), though moderate-to-vigorous physical activity (MVPA) time was below the guideline (58.68 ± 22.51 minutes/day); spent more than the recommended 60 minutes/day on screen time (169.91 ± 97.07 minutes/day); and slept less than 10 hours per night (9.44 ± 1.12 hours/day). Only 3% of the sample complied with the guidelines. PA showed the highest compliance (43%), compared to sleep duration (35%) and screen time (15%). Male sex was related to adherence to MVPA recommendations, while female sex, with adherence to total PA recommendations. Child's primary caregiver was the most important centrality indicator in the network., Conclusion: Only 3% of the assessed preschoolers are compliant with the 24-hour movement behaviors guidelines. Strategies to promote adherence to movement behaviors among low-income preschoolers should consider child's primary caregivers to support movement behaviors., (© 2020 Wiley Periodicals LLC.)

The aim was to describe the criteria for construction, validation of content, and appearance of a questionnaire for the identification of violence in affective relationships in adolescence. Transverse methodological study, with a quantitative approach, conducted in the period between June and November 2017, with the construction of a questionnaire and validation of the content and appearance, by means of a Delphi survey with 20 experts on the area of violence and adolescence. To evaluate the clarity and pertinence of the items of the questionnaire, a pilot test was conducted with 76 adolescents, and analysis of the validity of content and reliability of the items by means of Content Validity Index (CVI), the Interrater Agreement (IRA), and the Cronbach alpha. The data were analyzed and processed by means of the Excel and Stata , version 14.0, programs. The indexes calculated in the first round of Delphi provided the following results: CVI = 0.93 and IRA = 0.93, showing evidence of the validity and reliability of the construct content, and in the second round, the questionnaire yielded a percentage of 100% agreement among the professionals and researchers. Verification of the internal consistency presented a mean value of 0.803, calculated by means of the Cronbach alpha. The questionnaire has validity of content and appearance in accordance with the proposed objective, bearing in mind that the indexes of faithfulness and agreement and the Cronbach alpha attained values above those of the established pattern of 80%.

Background: To examine the associations between physical activity (PA) and sedentary behavior (SB) with walking capacity and the effects of reallocating time from SB to PA in patients with symptomatic peripheral artery disease (PAD) using compositional data analysis., Methods: This cross-sectional study included 178 patients (34% females, mean age = 66 [9] y, body mass index = 27.8 [5.0] kg/m2, and ankle-brachial index = 0.60 [0.18]). Walking capacity was assessed as the total walking distance (TWD) achieved in a 6-minute walk test, while SB, light-intensity PA, and moderate to vigorous-intensity PA (MVPA) were measured by a triaxial accelerometer and conceptualized as a time-use composition. Associations between time reallocation among wake-time behaviors and TWD were determined using compositional isotemporal substitution models., Results: A positive association of MVPA with TWD (relative to remaining behaviors) was found in men (βilr = 66.9, SE = 21.4, P = .003) and women (βilr = 56.5, SE = 19.8; P = .005). Reallocating 30 minutes per week from SB to MVPA was associated with higher TWD in men (6.7 m; 95% confidence interval, 2.6-10.9 m) and women (4.5 m; 95% confidence interval, 1.5-7.5 m)., Conclusions: The findings highlight, using a compositional approach, the beneficial and independent association of MVPA with walking capacity in patients with symptomatic PAD, whereas SB and light-intensity PA were not associated.

Purpose: The Structured Days Hypothesis (SDH) posits that children's behaviors associated with obesity - such as physical activity - are more favorable on days that contain more 'structure' (i.e., a pre-planned, segmented, and adult-supervised environment) such as school weekdays, compared to days with less structure, such as weekend days. The purpose of this study was to compare children's moderate-to-vigorous physical activity (MVPA) levels on weekdays versus weekend days using a large, multi-country, accelerometer-measured physical activity dataset., Methods: Data were received from the International Children's Accelerometer Database (ICAD) July 2019. The ICAD inclusion criteria for a valid day of wear, only non-intervention data (e.g., baseline intervention data), children with at least 1 weekday and 1 weekend day, and ICAD studies with data collected exclusively during school months, were included for analyses. Mixed effects models accounting for the nested nature of the data (i.e., days within children) assessed MVPA minutes per day (min/day MVPA) differences between weekdays and weekend days by region/country, adjusted for age, sex, and total wear time. Separate meta-analytical models explored differences by age and country/region for sex and child weight-status., Results/findings: Valid data from 15 studies representing 5794 children (61% female, 10.7 ± 2.1 yrs., 24% with overweight/obesity) and 35,263 days of valid accelerometer data from 5 distinct countries/regions were used. Boys and girls accumulated 12.6 min/day (95% CI: 9.0, 16.2) and 9.4 min/day (95% CI: 7.2, 11.6) more MVPA on weekdays versus weekend days, respectively. Children from mainland Europe had the largest differences (17.1 min/day more MVPA on weekdays versus weekend days, 95% CI: 15.3, 19.0) compared to the other countries/regions. Children who were classified as overweight/obese or normal weight/underweight accumulated 9.5 min/day (95% CI: 6.9, 12.2) and 10.9 min/day (95% CI: 8.3, 13.5) of additional MVPA on weekdays versus weekend days, respectively., Conclusions: Children from multiple countries/regions accumulated significantly more MVPA on weekdays versus weekend days during school months. This finding aligns with the SDH and warrants future intervention studies to prioritize less-structured days, such as weekend days, and to consider providing opportunities for all children to access additional opportunities to be active.

Background: Structured settings, such as school, childcare, afterschool programs, summer camps, and physical activity/sport programs are crucial to promoting physical activity (PA) opportunities and reducing sedentary (ST) for children and adolescents. However, little is known about how much PA and ST children and adolescents accumulate in structured settings. The aim of this study is to conduct a systematic review and meta-analysis of the absolute amount of time youth spend physically active and sedentary in different structured settings (Prospero number: 42018111804)., Methods: Observational and experimental/quasi-experimental studies (baseline data only) with full-text available, written in English and published in a peer-reviewed journal, reporting the total amount of objectively measured PA (light, moderate, vigorous, and/or total physical activity) and/or time spent ST during structured settings among youth (3 to 18 years) were eligible. Adjusted meta-analysis was conducted to estimate the pooled mean of time spent in PA and ST, by settings and sex., Results: A total of 187 studies (childcare n=60; school n=91; afterschool programs n=14; summer camp n=4; and Physical activity/ sport programs n=18) from 30 countries (47.9% United States), representing 74,870 youth (mean age 8.6 years old) were included. Overall, there was a high variation between studies in outcomes and settings. The meta-analyses revealed, on average, youth spend 221.8 minutes (36.7 min/hour) in ST and 32.1 minutes (5.1 min/hour) in MVPA during childcare hours, and 223.9 minutes (36.7min/hour) in ST and 27.8 min (4.4 min/hour) in MVPA at school. Relatively, youth are engaged in more MVPA in afterschool programs (11.7 min/hour), PA/ sport programs (20.9 min/hour), and summer camps (6.4 min/hour), when compared to childcare and school., Conclusion: Total PA accumulated during childcare and MVPA accumulated during schools hours were close to recommendations, despite high proportion of ST. Afterschool programs, summer camp and PA/ sport programs are important settings that can contribute to daily PA and reduced ST. Ensuring all youth have access to these structured settings may be an important step forward for public health.

Objectives: To identify patterns of non-dietary obesogenic behaviors, and social and environmental factors associated with overweight and obesity (OWOB)., Methods: A representative sample (n = 5520) of high school students (55.4% girls, 16.3 ± 1.0 years) from Pernambuco State, Brazil. Latent profile analyses were performed using self-reported daily sleep duration, television use, computer use, videogame use, seated time during the week and weekend days, physical activity, and active commuting to school during the week. Social and environmental factors and body mass index were included to identify classes. Multinomial analysis explored differences in social, environmental factors, and BMI by classes., Results: Five patterns were identified [Computer users (C1), Short sleepers (C2), Typical behaviors (C3), Techno-active-gamers (C4), and Lower screen engagement (C5)]. Three groups (C1, C3 and C4) included students from better social conditions and a more urbanized environments. The prevalence of OWOB was higher in C1 (34.5%; 95% CI 31.1-38.0) and in C2 (29.7%; 95% CI 26.1-33.5) compared to C5 (23.3% 95% CI 21.3-25.3)., Conclusions: In one of the poorest regions of Brazil, different groups of social/environmental factors and behavior patterns emerged associated with OWOB.

In Brazil, physical activity is a priority area in health promotion in the Brazilian Unified National Health System (SUS). The study aims to describe users' profiles and the barriers and facilitators in basic healthcare for participation in programs to promote physical activity. This was a statewide cross-sectional study in municipalities (counties) in Pernambuco State. Between 2 and 21 individuals were interviewed per municipality, using a previous tested instrument, validated in the following dimensions: sociodemographic; health status; participation; information on the program; reasons for participation; facilitators; barriers; and preference of activities. Descriptive and inferential analyses (chi-square) were performed. The sample consisted of 1,153 users, 35.9% of whom between 41-59 years of age; 90.1% lived in urban areas; 58.2% had participated in physical activities for at least a year. Weekly frequency of 3-4 days was 44.9%, and 71.1% practiced activities of an hour or more. The results showed that 40% of the barriers to participation in physical activity programs and 77.5% of the facilitators belonged to the intrapersonal domain. The most prevalent barrier was "current health condition" and the facilitator was the desire "to be healthier". Women perceived more barriers than men. The conclusion is that barriers and facilitators from the intrapersonal domain, related to health, are the main factors involved in users' engagement and retention in programs and interventions to promote physical activity, developed in basic healthcare services in the state of Pernambuco.

Objective: To evaluate the association between total physical activities, physical activity in free time and nutritional status with self-perceived health in adolescents of both genders., Methods: This is a quantitative study that integrates the school-based, cross-sectional epidemiological survey with statewide coverage, whose sample consisted of 6261 adolescents (14-19 years old) selected by random conglomerate sampling. Data were collected using the Global School-based Student Health Survey. The chi-squared test (χ 2 ) and the Poisson regression model with robust variance were used in the data analyses., Results: It was observed that 27.3% of the adolescents had a negative health self-perception, which was higher among girls (33.0% vs. 19.0%, p<0.001). After adjusting for potential confounding factors, it was observed that boys who did not practice physical activity during free time (PR=1.44, 95% CI: 1.15-1.81) and were classified as insufficiently active (PR=1.27, 95% CI: 1.04-1.56), as well as girls who did not practice physical activity during free time (PR=1.15, 95% CI: 1.02-1.29) and were classified as overweight (PR=1.27, 95% CI: 1.01-1.29) had a greater chance of negative health self-perception., Conclusion: Behavioral issues may have different effects on health self-perception when comparing boys with girls. Negative health self-perception was associated with nutritional status in girls and a lower level of physical activity in boys, and the practice of physical activity in the free time was considered a protective factor against a negative health self-perception for adolescents of both genders., (Copyright © 2018 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

This study evaluated the effect of a multi-component intervention on motor performance (MP) and metabolic risk markers (MRM) in overweight/obese youth. A secondary aim was to examine whether changes in MP are associated to changes in MRM. A 3-month multi-component intervention was performed, consisting of physical exercise sessions (twice/week;1h), nutritional education sessions (once/month), and parental support (twice/week). The sample included 35 volunteers (7-13 y.o), allocated to intervention (INT, n = 17) and control (CONT, n = 18) group. Variables were measured pre (T0) and post intervention (T1). Fasting blood samples were analyzed for MRM. MP tests included the measurement of health related physical fitness components and motor coordination performance (KTK battery). To assess food intake, a 24-hour recall diary was used. GLM-ANCOVA was performed. Standardized scores were calculated for the outcome variables, and multilinear regressions were applied to analyze associations between the key variables. INT group showed improvements in MP, glycolytic and hepatic profiles. After adjustments for MVPA, SB, total intake and maturational stage, negative associations between %ΔMP and %Δglycolytic (β = -.424; 95%CI:-0.343:-0.022), and %Δhepatic scores (β = -.382 95%CI:-0.001:-0.009) were observed. The intervention produced a moderate-to-high effect on the MP and some MRM. Changes in MP were inversely associated with changes in glycolytic and hepatic markers.

Objectives: The aim of the study is to assess STRONGkids as a tool for predicting weight loss and length of hospital stay in children and to determine whether the anthropometric diagnosis of nutritional status at the time of admission was associated with weight loss and length of hospital stay., Methods: A methodological study recruiting 245 children age between 1 and 10 years of age admitted to a tertiary hospital. The participants were weighed daily until discharge. Validation of the STRONGkids tool for the identification of patients sustaining weight loss at the end of hospitalization involved the calculation of sensitivity, specificity, and positive and negative predictive values, and anthropometric assessment., Results: A total of 129 (52.7%) children lost weight at the end of hospitalization. Of these, 73 (56.6%) lost over 2% of their weight on admission. The tool had a sensitivity of 55.8%, a specificity of 38.8% and a positive predictive value of 50.3% in identifying children who lost weight. The anthropometric assessment had a sensitivity of 26.5%, a specificity of 75.9%, and a positive predictive value of 49.1%., Conclusions: The model used to develop the STRONGkids tool incorporated clinical evaluation to a greater extent than the assessment of nutritional status. The tool, however, had a low sensitivity and a high percentage of false positives. Therefore, it should be considered as a preliminary evaluation tool and its use should be complemented with clinical data.

Objective: To identify the association between objectively measured physical activity and walking capacity with cognitive function in patients with symptomatic peripheral artery disease., Methods: This was an observational, cross sectional study. One hundred and thirty patients (age 67 ± 8 years) were recruited at a tertiary centre specializing in vascular disease. Cognitive function (global, memory, executive function and attention) was evaluated using the Montreal Cognitive Assessment tool. Physical activity levels (total, light, and moderate-vigorous) were obtained using an accelerometer. A 6 min and 4 m walk test were undertaken to assess walking capacity. Crude and covariate adjusted, linear regression analyses confirmed significant associations between physical activity levels and walking capacity with cognitive function., Results: Positive and significant associations were observed between moderate to vigorous physical activity (p = .039) and walking capacity (p = .030) with memory after adjusting for covariates. No significant association was identified between light physical activity and usual gait speed with any cognitive function outcome., Conclusion: Greater memory performance was associated with greater moderate to vigorous physical activity levels and walking capacity in patients with symptomatic peripheral artery disease. Clinical interventions focused on improving moderate to vigorous physical activity levels and walking capacity may provide important therapies to potentially enhance cognitive health in patients with peripheral artery disease., (Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Restricted sodium intake has been recommended for more than 1 century for the treatment of hypertension. However, restriction seems to increase blood cholesterol. In women with excess weight, blood cholesterol may increase even more because of insulin resistance and the high lipolytic activity of adipose tissue.The aim of this study was to assess the association between blood cholesterol and sodium intake in hypertensive women with and without excess weight.This was a cross-sectional study with hypertensive and nondiabetic women aged 20 to 59 years, recruited at the primary healthcare units of Maceio, Alagoas, Brazilian Northeast. Excess weight was defined as body mass index (BMI) ≥25.0 kg/m. Sodium intake was estimated by the 24-hour urinary excretion of sodium. Blood cholesterol was the primary outcome investigated by this study, and its relationship with sodium intake and other variables was assessed by Pearson correlation and multivariate linear regression using a significance level of 5%.This study included 165 hypertensive women. Of these, 135 (81.8%) were with excess weight. The mean sodium intake was 3.7 g (±1.9) and 3.4 g (±2.4) in hypertensive women with and without excess weight, respectively. The multiple normal linear regression models fitted to the "blood cholesterol" in the 2 groups reveal that for the group of hypertensive women without excess weight only 1 independent variable "age" is statistically significant to explain the variability of the blood cholesterol levels. However, for the group of hypertensive women with excess weight, 2 independent variables, age and sodium intake, can statistically explain variations of the blood cholesterol levels.Blood cholesterol is statistically inversely related to sodium intake for hypertensive women with excess weight, but it is not statistically related to sodium intake for hypertensive women without excess weight.

Background and Aims: Increased arterial stiffness is linked to increased risk of cardiovascular disease and mortality. Studies have reported conflicting results regarding the relationship between arterial stiffness and time spent in sedentary behavior (SB) and physical activity (PA). The objective of this systematic review and meta-analysis was to assess the relationship between objectively measured light PA (LPA), moderate to vigorous PA (MVPA), and SB with the gold standard measurement of arterial stiffness, carotid-femoral pulse wave velocity (cfPWV)., Methods: PubMed, Scopus, and Web of Science were searched for relevant studies published until November 2016. Studies reporting the correlation of objectively measured PA and SB with cfPWV in human adults >18 years old were included in this analysis. Correlation coefficients (CCs) were converted to Z scores via Fisher's z values for the analysis of summary effects, using a random-effects model., Results: Twelve studies were included in the systematic review. The meta-analysis showed a negative correlation between cfPWV and LPA (CC -0.16; 95% CI: -0.29 to -0.03; p=0.02) and MVPA (CC -0.16; 95% CI: -0.26 to -0.06; p<0.01), and a positive relationship between cfPWV and SB (CC 0.23; 95% CI: 0.12 to 0.35; p<0.01)., Conclusions: Time spent in light and moderate physical activities is associated with lower arterial stiffness, while time spent in SB is related to higher arterial stiffness. It suggests that PA at any intensity is favorable for arterial stiffness, whereas SB leads to increased arterial stiffness. Considering that cfPWV has an independent prognostic value, these associations may have important clinical implications., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The aim of this study was to analyze the influence of the number of visits and the number of blood pressure (BP) measurements on the prevalence of high blood pressure (HBP) in adolescents. A cross-sectional epidemiologic study with 481 adolescents (14-19 years old) selected using a random cluster sampling strategy. We measured the BP three times in a first visit. Adolescents with HBP performed subsequent visits. The final calculation of BP followed four strategies: the 1st measure, mean of 1st and 2nd measurements, mean of all three measurements, and averaging the 2nd and 3rd measurements. The prevalence of HBP in the first and second visits was 6.4% and 1.9%, and the prevalence of hypertension (after three visits) was 1.7%. The prevalence of HBP varied from 8.6%-18.6% for boys and 4.6%-9.2% for girls, using the average 2nd and 3rd measurements and the 1st measurement, respectively. In all strategies, HBP and hypertension were more prevalent in boys and students attending the nocturnal shift. The number of visits and number of measurements affect the prevalence of HBP and hypertension in adolescents. Thus, clinicians and researchers should consider these aspects when assessing BP in adolescents aged 14-19 years old., (Copyright © 2017 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.)

Objective: To translate, cross-culturally adapt, and validate a specific questionnaire for the evaluation of celiac children and adolescents, the celiac disease DUX (CDDUX)., Methods: The steps suggested by Reichenheim and Moraes (2007) were followed to obtain conceptual, item, semantic, operational, and measurement equivalences. Four pediatric gastroenterologists; a researcher with tool validation background; three English teachers; and 33 celiac patients, aged 8-18 years, and their caregivers participated in the study. The scores of celiac patients and those obtained from their caregivers were compared. Among the patients, the scores were compared in relation to gender and age., Results: All items were considered relevant to the construct and good semantic equivalence of the version was acquired. During measurement equivalence, the exploratory factor analysis showed appropriate weight of all items and good internal consistency, with Cronbach's α of 0.81. Significant difference was found among the final scores of children and their caregivers. There was no difference among the final scores in relation to gender or age., Conclusion: The questionnaire was translated and adapted according to all the proposed steps, with all equivalences adequately met. It is a valid tool to access the QoL of celiac children and adolescents in the translated language., (Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

OBJECTIVE Translate the Patient-centered Assessment and Counseling for Exercise questionnaire, adapt it cross-culturally and identify the psychometric properties of the psychosocial scales for physical activity in young university students. METHODS The Patient-centered Assessment and Counseling for Exercise questionnaire is made up of 39 items divided into constructs based on the social cognitive theory and the transtheoretical model. The analyzed constructs were, as follows: behavior change strategy (15 items), decision-making process (10), self-efficacy (6), support from family (4), and support from friends (4). The validation procedures were conceptual, semantic, operational, and functional equivalences, in addition to the equivalence of the items and of measurements. The conceptual, of items and semantic equivalences were performed by a specialized committee. During measurement equivalence, the instrument was applied to 717 university students. Exploratory factor analysis was used to verify the loading of each item, explained variance and internal consistency of the constructs. Reproducibility was measured by means of intraclass correlation coefficient. RESULTS The two translations were equivalent and back-translation was similar to the original version, with few adaptations. The layout, presentation order of the constructs and items from the original version were kept in the same form as the original instrument. The sample size was adequate and was evaluated by the Kaiser-Meyer-Olkin test, with values between 0.72 and 0.91. The correlation matrix of the items presented r < 0.8 (p < 0.05). The factor loadings of the items from all the constructs were satisfactory (> 0.40), varying between 0.43 and 0.80, which explained between 45.4% and 59.0% of the variance. Internal consistency was satisfactory (α ≥ 0.70), with support from friends being 0.70 and 0.92 for self-efficacy. Most items (74.3%) presented values above 0.70 for the reproducibility test. CONCLUSIONS The validation process steps were considered satisfactory and adequate for applying to the population.

Objective: It was to investigate the cluster of four main risk behaviors (smoking, alcohol, physical inactivity and low consumption of fruits and vegetables) related to chronic diseases from Northeastern Brazil., Methods: Cross-sectional study with a representative sample (n = 600) of high school students from public schools in Caruaru, Pernambuco, Brazil. The cluster was evaluated by comparing the observed prevalence expected in all the possibilities of coupling between the behaviors. The logistic regression analysis was performed by grouping three or four behaviors, after adjusting for independent variables., Results: With the exception of smoking, other risk behaviors had prevalence rates above 20%. Only 0.3% (95%CI 0.1 - 1.3) of the students presented the four risk behaviors simultaneously, while 15.3% (95%CI 12.3 - 18.2) did not present anyone. Risk behaviors tended to cluster, particularly smoking and alcohol consumption, being more pronounced among boys, and physical inactivity and low consumption of fruits and vegetables among girls (p < 0.05). Regression analysis indicated that, among the independent variables, those students who do not have physical education classes were 2.1 times more likely to have three or more risk behaviors added., Conclusions: The results of this study allow us to establish the prevalence of risk behaviors in cluster, which may have important implications for health policies and practices. It is suggested that educational and health actions are tested in schools, and physical education classes can be an important context for intervention.

The objective of this study was to translate, adapt, and test the psychometric properties of psychosocial scales on fruits and vegetable consumption. A multidimensional questionnaire based on constructs of Social Cognitive Theory and the Transtheoretical Model was administered to 717 university students. Validation procedures included conceptual, item, semantic, operational, measurement, and functional equivalence. Exploratory factor analysis and temporal stability were performed using SPSS (17.0). Small differences between the translated versions were observed, and a few adjustments were made. The explained variance ranged from 57.3% to 63.2%, and alpha values ranged from 0.77 to 0.88, showing good internal consistency. Average temporal stability was good, and all constructs correlated with the stages of behavior change (p < 0.05). All validation steps were satisfactory and deemed appropriate for application in the population.

A school-based cross-sectional study in 2007 evaluated the prevalence and associated factors of daily consumption of soft drinks, sweets and fried foods among adolescents (15 to 20 years of age) in public schools in Caruaru in the state of Pernambuco. To evaluate the factors associated with the daily consumption of the above foods, a multivariate and hierarchical analysis was conducted using Poisson regression, with social and demographic variables at the first hierarchical level, behavioral variables at the second level and dietary standards at the third level. Consumption of soft drinks, sweets and fried foods at least once a week was declared by 90.9%, 95.4% and 89.6% of the adolescents, respectively. The corresponding prevalence of the daily consumption of these items was 30.2%, 42% and 28.3%. The daily consumption of sweets was 21% higher among girls and 25% higher among adolescents who ate rice and beans daily. With respect to fried foods, girls mentioned 37% greater consumption than boys. Adolescents who consumed meat every day admitted a 43% higher daily consumption of fried foods. The consumption of soft drinks, sweets and fried foods among the adolescents from Caruaru was high and showed a homogeneous consumption standard for most variables analyzed.

This is a cross-sectional school-based study that evaluated the prevalence and associated factors of the daily intake of fruit and vegetables by adolescents at public schools in Caruaru, Pernambuco. Poisson regression with a hierarchical model, including sociodemographic variables in the first hierarchical level, behavioral variables in the second and diet-related variables in the third was used to assess the factors associated with fruit and vegetable intake. The results showed that of the 600 adolescents interviewed, 10% reported never eating fruit and 30.7% mentioned not eating vegetables. Prevalence of fruit intake was 32.9% and vegetables 29.0%. Only 6.5% reported eating both kinds of food daily. Merely the daily vegetable intake showed a significant difference according to sex (higher among girls). Daily fruit intake was 63% higher among adolescents living in urban areas. Not consuming alcohol was associated with higher fruit intake, though not to vegetable intake. Daily intake of fruits and vegetables was 2.4 times higher among adolescents who consumed rice and beans daily. Daily fruit and vegetable intake among adolescents in Caruaru is below the recommendations, and was associated with gender, residence area, consumption of alcoholic beverages and consumption of rice and beans.

Objective: To investigate the clustering of risk behaviors for chronic non-communicable diseases and their associated factors among adolescents from Southern Brazil., Methods: In 2008, a survey was conducted with 3990 adolescents aged 14-15 years (mean: 14.3; SD: 0.6) from the 1993 Pelotas Birth Cohort Study. Clustering was determined by comparing observed (O) and expected (E) prevalence of all possible combinations of the four risk factors investigated (smoking, alcohol intake, low fruit intake, and physical inactivity). We carried out Poisson regression to evaluate the effect of individual characteristics on the presence of at least three risk behaviors., Results: All risk factors tended to cluster together (O/E prevalence=3.0), especially smoking and alcohol intake (odds ratio to present on behavior in the presence of other >5.0). Approximately 15% of adolescents displayed three or more risk behaviors. Females (adjusted OR=1.55), people 15 years and older (OR=1.47), with black skin color (OR=1.23), and of low socioeconomic level (OR=1.29) were more likely to display three or more risk factors., Conclusion: These findings suggest that lifestyle-related risk factors tend to cluster among adolescents. Identifying subgroups at greater risk of simultaneously engaging in multiple risk behaviors may aid in the planning of preventive strategies., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To identify the prevalence of factors associated with insufficient physical activity levels and sedentary behavior among adolescents., Methods: In this cross-sectional study 4,210 students (14-19 years old) attending public high-schools were selected using random two-stage cluster sampling. Data were collected by using the Global School-based Student Health Survey. Subjects who reported performing 60 minutes or more of moderate to vigorous physical activity five days a week or more were classified as physically active, while the remainder was classified as insufficiently active. Subjects who reported watching TV three or more hours a day were considered to be exposed to sedentary behavior. Analyses were carried out by using Chi-square tests and binary logistic regression., Results: The prevalence of insufficiently active subjects was 65.1% (CI95% 63.7-66.6). Gender, place of residence (rural/urban), time of day attending school, occupational status, and enrollment in physical education were identified as factors significantly associated with exposure to insufficient levels of physical activity. Prevalence of exposure to sedentary behavior was 40.9% (CI95% 39.4-42.4) on week days and 49.9% (CI95% 48.4-51.4) on weekend days. Place of residence, time of day attending school, occupational status and enrollment in physical education were identified as factors significantly associated with exposure to sedentary behavior on week days, whereas on weekend days exposure to sedentary behavior was related to gender, age and time of day attending school., Conclusion: This study showed a high prevalence of insufficient physical activity levels and exposure to sedentary behaviors among adolescents.

Background: Physical education (PE) plays a critical role in the healthy development of youth; however, the influence of PE classes in helping to provide students with health-related behavior patterns is not clear. This study aims to analyze whether participation in PE classes is associated with health-related behavior among high school students., Methods: A total of 4210 students attending public high schools in Pernambuco (northeast of Brazil) were selected using random 2-stage cluster sampling. Data were collected by using the Global School-based Student Health Survey. The independent variable was the frequency of participation in PE classes, whereas physical activity, television viewing, smoking, and alcohol, fruit, vegetables and soda consumption were dependent variables. Logistic regressions were carried out to perform crude and adjusted analysis of the association between enrollment in PE classes and health-related behaviors., Results: Sixty-five percent of students do not take part in PE classes, with a significantly higher proportion among females (67.8%). It was observed that enrollment in PE classes was positively associated with physical activity, TV viewing, and fruit consumption, but was negatively associated with soda drinking. The likelihood of reporting being active and eating fruit on a daily basis was 27% and 45% higher, respectively, among those who participate in at least 2 classes per week in comparison with those who do not. Students who participate in PE classes had 28-30% higher likelihood of reporting lower TV viewing during week days., Conclusions: Findings suggest that higher levels of enrollment in PE classes could play a role in the promotion of health-related behaviors among high school students.

The aim of this study was to describe the profile of users and non-users of the Academia da Cidade Program to promote physical activity in Recife, Pernambuco State, Brazil. Four of the program's 19 units were sampled. Users (n=277) and non-users (n=277) were matched for gender, age (+/-5 years), and place of residence. Among non-users, 22% had never heard of the program. Among those who knew of the program, 54.3% learned about it by actually having seen one of the units. Among users, the main reason for participating in the program was to improve their health; mean participation time was 27.5 months (SD = 23.1); and 72.8% reported high satisfaction. The proportion of individuals with fair or poor self-rated health was significantly higher among non-users (45.4%) than users (28.5%). Users of the program appeared to be satisfied. Strategies to further publicize the program should be prioritized to make it known to a larger proportion of the city's population.

This study aims to analyze the association between demographic, socioeconomic, school-related, and behavioral factors and overweight and obesity in adolescents. The sample included 4,210 public high school students (14-19 years old) in Pernambuco State, Brazil, selected by two-stage cluster sampling. Obesity and overweight were assessed using anthropometric measurements, and the Global School-Based Health Survey was used to collect personal and behavioral data. The cutoff points for defining overweight and obesity were those recommended by the International Obesity Task Force. Prevalence rates for overweight and obesity were 11.5% (95%CI: 10.7-12.8) and 2.4% (95%CI: 1.9-2.9), respectively. Overweight and obesity were more common in males who reported residing in urban areas and were not enrolled in physical education classes. Watching television 3+ hours/day was associated with obesity in females. Reducing TV time and encouraging enrollment in physical education could be effective measures to counteract the growing obesity trends.