An initiative to increase the amount of physical activity undertaken in Brazil is improving citizens health and providing a model for other nations. Carlos Henrique Fioravanti reports.
4 years after a government plan to build more walking and cycling tracks, parks, and leisure spaces, Sorocaba—a city of 600 000 inhabitants in the state of São Paulo, Brazil—has recorded a 50% decrease in hospital admissions for hypertension (from 1·89 cases per 10 000 people in 2008 to 0·99 in 2011). This result is linked to the adoption of the principles of Agita São Paulo, a comprehensive programme aimed at promoting physical activity and enhancing the quality of life of the 40 million inhabitants in the state of São Paulo, the most populated in the country.
4 years after a government plan to build more walking and cycling tracks, parks, and leisure spaces, Sorocaba—a city of 600 000 inhabitants in the state of São Paulo, Brazil—has recorded a 50% decrease in hospital admissions for hypertension (from 1·89 cases per 10 000 people in 2008 to 0·99 in 2011). This result is linked to the adoption of the principles of Agita São Paulo, a comprehensive programme aimed at promoting physical activity and enhancing the quality of life of the 40 million inhabitants in the state of São Paulo, the most populated in the country.
In São Paulo and other Brazilian states, Agita (meaning move) has encouraged health authorities, mayors, academic researchers, physicians, and community leaders to find creative ways to stimulate physical activity. For example, in Uberlândia, in the state of Minas Gerais, residents are walking in the cemetery as well as in parks, after local authorities repaired the paths in and around the city's cemetery and pointed out that people, by walking more, could delay the day that they would be buried in the grounds.
The programme values the autonomy of its participants, proposing that every person should do half an hour of moderate intensity physical activity at least 5 days a week, at home, outside, at work, or on the way to work. “We recommend walking, because it is easy”, Timoteo Araujo, the programme scientific director, says. “Most importantly, physical activity should be a source of pleasure and joy.”
Beyond the direct health benefits, regular physical activities and small changes to our daily lives—simply avoiding lifts and parking a little further away to walk more—could reduce sedentary habits, which are linked to increases in the prevalence of diabetes and obesity. Even though these steps seem small, “the adoption of one healthy habit usually brings other healthy habits”, Araujo argues. The approach has helped WHO to value physical activity as a way of improving public health and has inspired other countries to adopt Agita's principles to their own cultures and climates.
Araujo works for the Center of Studies at the Physical Fitness Research Laboratory in São Caetano do Sul (CELAFISCS), a non-governmental organisation that runs Agita. The programme has been funded by a yearly grant of US$150 000 from the São Paulo state health department since 1995, when it was officially approved. Since then, it has been linked to a decrease in sedentarism from 9·6% in 2002 to 2·7% in 2008 and, according to a 2005 World Bank report, to a saving of $310 million per year in the health budget of the state of São Paulo.
The programme is always on the news because of the mega-events that it promotes every year, which are led by CELAFISCS director Victor Matsudo— an expert on sports medicine who started speaking out about physical activity to promote health when he was a teenager. On the first Sunday of April, around 15 000 people of all ages took part in a walk in São Paulo city, many of them wearing a white T-shirt with the inscription Agita Mundo (move world), accompanied by the lively sound of regional music. On the last Friday of August, as in previous years, the benefits of physical activities will be discussed by about 200 000 teachers and 4·5 million students in 4460 public schools in the state of São Paulo. As there is no formula to follow, sometimes the results are surprising. “Some open-minded school directors let students turn the music up and dance between classes, while the snack bar owner has reduced the salt levels of the snacks”, Araujo says. Initiatives like these, he argues, “help students to do their best in all subjects, including physical education”.
As important as constant visibility is evaluation. Agita coordinators meet city officers, international partners, and academic researchers every month to discuss their progress and to plan the next steps. A current priority is to work more intensively in companies and hospitals to attract new participants and reduce the dependency on government funding.
Luiz Porto, a university researcher and Agita's adviser, runs a programme of physical activities aimed at improving the health habits of the 2500 employees in the Supreme Labour Court in Brasilia, the capital of Brazil. Some people do not do physical activity due to lack of time, but he reminds them that the recommended 30 minutes of daily practice can be divided in two parts of 15 minutes or three of 10, “the benefit to health will be the same”. Porto observed that many former sedentary workers were among the 73 participants in the Green Run on June 3, the first activity of a recently created runners' club. “Lifestyle changes”, he says, “are progressive, step by step.”
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