Teses e Dissertações

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Abstract: With the consolidation of the scientific knowledge on the benefits of physical activity for health, and the dissemination of this knowledge, a growing number of governmental and non-governmental health promotion strategies have been launched, with particular emphasis on physical activity promotion ones. In Brazil, this is particularly true, and the Brazilian model of health promotion through physical activity is a model for other countries. The Physical Activity Network funded by the Brazilian Ministry of Health was evaluated as part of this thesis, in a study that included interviews to 748 coordinators of physical activity interventions in all regions of the country. They were interviewed about offer, utilization, coverage, impact/result, structure and process indicators. We then listed all cities from the Rio Grande do Sul state which were funded through the network, and identified Panambi as the only one who was funded in every single year of the cycle (2005-2009). We then conducted a population-based study in Panambi including 1,158 adults in order to evaluate the association between exposure to physical activity promotion strategies and physical activity levels. Finally, we carried out a narrative literature review on the evaluation indicators presented in articles about the main physical activity promotion strategies in Brazil, including the analysis of their logic models. As a general result of these studies, it can be said that Brazil is treading a promising regarding the promotion of physical activity, but a systematic evaluation processes should be the target of reflection in order that interventions have the greatest potential for effectiveness and impact.
Artigo 1: Description of the physical activity promotion programs funded by the Brazilian Ministry of Health.

Abstract: As a means to operationalize the National Health Promotion Policy, the Brazilian Ministry of Health funded cities for the development of local health promotion interventions from 2005 to 2009. Out of 1,374 interventions funded in this period, approximately 3/4 developed physical activity promotion strategies. The aim of this article is to describe these interventions. We interviewed those who are responsible for these interventions in 748 cities in Brazil. The Midwest region was the one with the highest proportion of cities being funded (17.8%); 72.3% of the interventions take place in small cities, i.e. those with fewer than 30,000 inhabitants. Communication, education and information strategies were the mostly frequently reported, followed by behavioral and social strategies. Only 8.2% of the interventions achieve more than 500 people. Most interventions (76.9%) focused on older adults, and 59.2% of them were designed for hypertensive and diabetic patients. Oriented walking was the most prevalent offered activity (80.6%), followed by gym classes (78.5%). Most interventions used parks or squares (55.6%) or sports courts (52%). Radio was the most frequent media strategy used (59.8%) to divulgate the interventions. Lack of adequate physical structure and personnel were the main barriers faced by the interventions (30.3%), followed by bureaucracy at obtaining and using the funding (25.1%). Physical education teachers were present in 72.3% of the interventions. The low proportion of funded cities in the North region, the lack of interventions using environmental and policy strategies, inadequate infrastructure and insufficient personnel are key areas in which interventions can improve in order to be more successful.

Artigo 2: The physical activity promotion in Panambi, Brazil: a population base study.

Abstract: Panambi, a medium-sized city located in the Rio Grande do Sul State, Brazil, was the only city in the state to be funded by the Ministry of Health for the development of physical activity (PA) intervention every year from 2006 to 2009. A population-based survey was conducted in the city with the aim of describing the various interventions strategies taking place in the city, as well as comparing PA and health indicators among users, former users and non-users of such interventions. A total of 1,158 individuals aged 18 years or older were interviewed. Over half of them 52.9%) were aware of any PA intervention taking place in the city, 5.2% were current users of at least one of the interventions and 8.1% were former users. Users were more likely to be active (150 min/wk or more) in leisure-time (55.7%) and commuting (36.1%), as compared to both former users (23.4% and 22.4%, respectively) and non-users (21.9% and 25.5%, respectively). Positive social support for PA was more prevalent among the "users". Were detected 17 actions directly or indirectly related to the promotion of PA, financed and / or implemented by the local government. However, PA levels were not higher than those found in other studies, which should be subject to discussion and analysis for better understanding of this scenario.

Artigo 3: Physical activity promotion programs in Brazil: a systematic literature review focusing on evaluation indicators.
The aim of the present review was to evaluate the indicators proposed by Habitch and Donabedian, relative to physical activity promotion programs in Brazil, and to discuss the logic models guiding such interventions. We identified 10 interventions, 9 of them funded by governmental institutions. In terms of evaluation indicators, result (40.9%), utilization (22.7%) and offer/structure/process (19.7%) was mentioned more frequently in the articles. The logic models of the programs analyzed have a standard structure and indicate that the main concern is to increase the physical activity levels of the participants. However, the logic models has been little considered in the performing the evaluations. The evaluation process of programs to promote physical activity needs to be systematized in order to give more consistency to the results presented and allow there to be more sure that resources are well used.