RESUMO
BACKGROUND: Although low levels of physical activity have slightly decreased globally, the need to reverse the physical inactivity remains urgent. One approach has been the installation of outdoor gyms (OGs). METHOD: A natural experiment arose from the installation of OGs in different neighborhoods of the city of Temuco, Chile. Baseline measurements were collected between 2006 and 2017 in a cohort of adults participating in the Prospective Urban & Rural Epidemiology study. Physical activity was assessed with the short version of the International Physical Activity Questionnaire, and time-varying covariates was assessed every 3 years. The multistage hierarchical, nested sampling process and the follow-up assessments led to data correlated at different levels, thus the authors analyzed the data using a logistic multilevel model. RESULT: 2463 urban adults from 16 neighborhoods, with an average age of 51.7 (9.8) years (67% female), were included. Having an adequate number of OGs improved the odds of complying with the World Health Organization's recommendations (adjusted odds ratio = 4.64, 3.95-5.45). In addition, being male (odds ratio = 1.53, 1.32-1.77) and under the age of 60 years (odds ratio = 0.83, 0.71-0.97) were associated with being physically active. CONCLUSION: The presence of more OGs can have a positive impact on physical activity recommendations.
Assuntos
Exercício Físico , Características de Residência , Adulto , Chile , Cidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
INTRODUCTION: Cardiac rehabilitation (CR) programmes are well established, and their effectiveness and cost-effectiveness are proven. In spite of this, CR remains underused, especially in lower-resource settings such as Latin America. There is an urgent need to create more accessible CR delivery models to reach all patients in need. This trial aims to evaluate if the prevention of recurrent cardiovascular events is not inferior in a hybrid CR programme compared with a standard programme. METHOD AND ANALYSIS: A non-inferiority, pragmatic, multicentre, parallel (1:1), prospective, randomised and open with blinded endpoint assessment clinical trial will be conducted. 308 patients with coronary artery disease will be recruited consecutively. Participants will be randomised to hybrid or standard rehabilitation programme. The hybrid CR programme includes 10 supervised exercise sessions and individualised lifestyle counselling by a physiotherapist, with a transition after 4-6 weeks to unsupervised delivery via text messages and phone calls. The standard CR consists of 18-22 supervised exercise sessions, as well as group education sessions about lifestyle. Intervention in both groups is between 8 and 12 weeks. The primary outcome is a composite of cardiovascular mortality and hospitalisations due to cardiovascular causes. Secondary outcomes are health-related quality of life, exercise capacity, muscle strength, heart-healthy behaviour, return-to-work, cardiovascular risk factor, adherence, and exercise-related adverse events. The outcomes will be measured at the end of intervention, at 6 months and at 12 months follow-up from recruitment. The primary outcome will be tracked through the end of the trial. Per-protocol and intention-to-treat analysis will be undertaken.Cox regression model will be used to compare primary outcome among study groups. ETHICS AND DISSEMINATION: Ethics committees at the sponsor institution and each centre where participants will be recruited approved the study protocol and the Informed Consent. Research findings will be published in peer-reviewed journals; additionally, results will be disseminated among region stakeholders. TRIAL REGISTRATION NUMBER: NCT03881150; Pre-results. DATE AND VERSION: 01 October 2019.
Assuntos
Síndrome Coronariana Aguda/reabilitação , Reabilitação Cardíaca/métodos , Doenças Cardiovasculares/mortalidade , Doença da Artéria Coronariana/reabilitação , Hospitalização/estatística & dados numéricos , Chile , Aconselhamento/métodos , Terapia por Exercício/métodos , Tolerância ao Exercício , Comportamentos Relacionados com a Saúde , Humanos , Estilo de Vida , Força Muscular , Educação de Pacientes como Assunto/métodos , Fisioterapeutas , Modelos de Riscos Proporcionais , Qualidade de Vida , Retorno ao Trabalho , Telefone , Envio de Mensagens de TextoRESUMO
OBJECTIVES: The objective is to describe hypertension (HTN) prevalence, awareness, treatment and control in urban and rural communities in Latin America to inform public and policy-makers. METHODS: Cross-sectional analysis from urban (n = 111) and rural (n = 93) communities including 33 276 participants from six Latin American countries (Argentina, Brazil, Chile, Colombia, Peru and Uruguay)were included. HTN was defined as self-reported HTN on blood pressure (BP)medication or average BP over 140/90 mmHg, awareness as self-reported HTN, and controlled as those with BP under 140/90 mmHg. RESULTS: Mean age was 52 years,60% were Female and 32% belonged to rural communities. HTN prevalence was 44.0%, with the lowest rates in Peru (17.7%) and the highest rates in Brazil (52.5%)58.9% were aware of HTN diagnosis and 53.3% were receiving treatment. Prevalence of HTN were higher in urban (44.8%) than rural (42.1%) communities in all countries. Most participants who were aware of HTN were receiving medical treatment (90.5%), but only 37.6% of patients receiving medical treatment had their BP controlled (<140/<90 mmHg), with the rates being higher in urban (39.6%) than in rural (32.4%) communities. The rate of use of two or more drugs was low [36.4%, lowest in Argentina (29.6%) and highest in Brazil (44.6%)]. Statin use was low (12.3%), especially in rural areas (7.0%). Most modifiable risk factors were higher in people with HTN than people without HTN. CONCLUSION: HTN prevalence is high but BP control is low in Latin America, with marked differences between countries and between urban and rural settings. There is na urgent need for systematic approaches for better detection, treatment optimization and risk factor modification among those with HTN in Latin America.(AU)
Assuntos
Humanos , Políticas de eSaúde , Hipertensão/epidemiologia , América Latina/epidemiologiaRESUMO
OBJECTIVES: The objective is to describe hypertension (HTN) prevalence, awareness, treatment and control in urban and rural communities in Latin America to inform public and policy-makers. METHODS: Cross-sectional analysis from urban (nâ=â111) and rural (nâ=â93) communities including 33â276 participants from six Latin American countries (Argentina, Brazil, Chile, Colombia, Peru and Uruguay) were included. HTN was defined as self-reported HTN on blood pressure (BP) medication or average BP over 140/90âmmHg, awareness as self-reported HTN, and controlled as those with BP under 140/90âmmHg. RESULTS: Mean age was 52 years, 60% were Female and 32% belonged to rural communities. HTN prevalence was 44.0%, with the lowest rates in Peru (17.7%) and the highest rates in Brazil (52.5%). 58.9% were aware of HTN diagnosis and 53.3% were receiving treatment. Prevalence of HTN were higher in urban (44.8%) than rural (42.1%) communities in all countries. Most participants who were aware of HTN were receiving medical treatment (90.5%), but only 37.6% of patients receiving medical treatment had their BP controlled (<140/<90âmmHg), with the rates being higher in urban (39.6%) than in rural (32.4%) communities. The rate of use of two or more drugs was low [36.4%, lowest in Argentina (29.6%) and highest in Brazil (44.6%)]. Statin use was low (12.3%), especially in rural areas (7.0%). Most modifiable risk factors were higher in people with HTN than people without HTN. CONCLUSION: HTN prevalence is high but BP control is low in Latin America, with marked differences between countries and between urban and rural settings. There is an urgent need for systematic approaches for better detection, treatment optimization and risk factor modification among those with HTN in Latin America.