Lighting the Fire
The Brazil Experience
Active Caribbean Workshop 2009
Road to the Wellness Revolution
Victor Matsudo
matsudo@celafiscs.org.br
Barbados
March 6th, 2009
“The Samba – Caribbean Connection”.
Time for Action; and for Revolution !
It is not a Matter of What ;
But a Matter of How !
* * * * *
CELAFISCS
Center of Studies of the Physical Fitness
Research Laboratory - São Caetano do Sul
CELAFISCS - Executive Board
Sandra Matsudo
General Director
Erinaldo L de Andrade
Secretary General
Timóteo L Araújo
President
Victor Matsudo
Scientific Director
Gláucia F Braggion
2nd Secretary
Luis C de Oliveira
Vice-President
Douglas R Andrade
Past-Vice-President
CELAFISCS Family !
We have a dream
Subsistence
Efficiency
3:1
3000 Kcal d-1
1000 Kcal d-1
2100 Kcal d-1
Subsistence
Efficiency
7:1
300 Kcal d-1
Pre-Industrial
CELAFISCS - Agita São Paulo
Contemporary
International Association for the Study of Obesity, 2003
Prevalence of Risk Factors in São Paulo
70
69,3
%
60
50
37,9
40
30
22,3
18
20
10
7,7
9,7
0
Alcholism
Diabetes
Obesity
Hypertension
Tabagism
Sedentarism
Rego et al. Braz J Pub Health,1990
Any Leisure-Time Physical Acitvity According
to Socio-Economic Level
40
25% POOREST
25%
25%
25% RICHEST
31,5
30
%
21,5
18
20
12,7
10
8,3
6,5
7,2
1,3
0
MEN
WOMEN
Monteiro & Matsudo, Pan American Journal Public Health, 14(4):246-253,2003
Gender and Educational Level &
Probability of engaging in any LTPA
20
15
OR
17,27
MEN
WOMEN
Education
10
6,11
5,44
5
5,05
3,01
1
1
1,59
0
1st
2nd
3rd
n: 11.033 – H: 5234 / M: 5799 – > 20 anos 4.800 – Home-Interview
4th
Monteiro C, Matsudo S, 2003
World deaths in 2000 attributable to selected
leading risk factors
Blood pressure
Tobacco
Cholesterol
Underweight
Sedentarism
Unsafe sex
Fruit and vegetable intake
High Body Mass Index
2 Million Deaths
Physical inactivity
Alcohol
Unsafe water, sanitation, and hygiene
Indoor smoke from solid fuels
Iron deficiency
Urban air pollution
Zinc deficiency
Vitamin A deficiency
Unsafe health care injections
Occupational risk factors for injury
WHO, 2005
0
1000
2000
3000
4000
5000
Number of deaths (000s)
6000
7000
8000
Do Scientific
Evidences
Change
Behavior ?
Angina Incidence
(1949-1950)
Cardio-vascular
deathes
Total
Morris et al. 1953
HIP FRACTURE IN MEN BY CHANGE IN PHYSICAL ACTIVITY
BETWEEN 50 AND 60 YEARS OF AGE
Cumulative Percentage with
Hip Fracture (%)
35 YEARS OF FOLLOW-UP
2,34 (1,41-3,88)
Constant low or medium physical activity
Reduced from high to medium physical activity
16
1,92 (1,07-3,42)
Increased from low or medium to high physical activity
12
Constant high physical activity
1,44 (0,76-2,74)
8
1 reference
4
0
60
65
70
2.205 HOMENS
Born Between 1920 and 1924
Cohort
Uppsala Longitudinal Study of Adult Men (ULSAM)
75
80
85
90
Age in Years
MICHAELSSON, K. et al.PLoS. Med. 4 (6):1094:1100,2007
PHYSICAL ACTIVITY AND HIP
FRACTURE IN MEN
35 YEARS OF FOLLOW-UP
2,65
HAZARD RATIOS
3
(1,55-4,24)
1,65
(1,13-2,41)
2
1
Ref.
1
0
High
2.205 HOMENS
Born Between 1920 and 1924
Cohort
Uppsala Longitudinal Study of Adult Men (ULSAM)
Medium
Low
PHYSICAL ACTIVITY
MICHAELSSON, K. et al.PLoS. Med. 4 (6):1094:1100,2007
Associations Between Breast Cancer Outcomes and Physical Activity 2
Years After Diagnosis
P for Trend = 0.046
P for Trend = 0.014
67%
0
0 MET -h/wk
0 - 8.9 MET -h/wk
64%
0.15 - 0.73
0.17 - 0.73
70%
0.15 - 0.61
59%
0,5
0.21 - 0.78
Harzad Ratios
1
> 9 MET h/wk
Adjusted for Age
Adjusted for age, race, disease stage, initial treatment, tamoxifen use, body mass index, and fruit/vegetable servings per day
933 women
x Age= 55.5
Irwin et al, J Clin Oncol 26:3958-3964, 2008
Relative Risk of Gastric and Esophagic Carcinoma
According to Physical Actitivty
Noncardia Gastric Adenocarcinoma
p for trend 0,024
1,2
Relative Risk
1
1
0,8
0,4
0,68
0,67
0,6
Ref.
(0.46 – 0.98)
(0.49 – 0.95)
0,65
(0.47 – 0.89)
0,2
0,62
(0.44 – 0.87)
- 38%
0
0
Cohort 487.732 Homens e Mulheres
50 a 71 Anos de Idade
8 Anos de Seguimento
523 Casos de Carcinoma Esofágico
642 Casos de Carcinoma Gástrico
<1
1a2
3a4
>5
Physical Activity (Times / Week
NIH – AARP Diet and Health Study
LEITZMANN MF et al.Am. J. Preventive Medicine 2009; 36(2) :112-119
Publications on P.A.& CVD
Total: 8940
10 years: 5284
5 years: 3224 last yr: 645
Humans: 7774
10 years: 4646
5 years: 2814 last yr: 511
Bergamaschi, J. May 30th, 2007
Physical Activity Academic Paradox
Physical Activity
Published Papers
1960
70
80
90
2000
Matsudo, V Sea Pines Course, 2003
Free Thinking…
Worst than a Tragedy is
Not to Learn with the Tragedy !
Medical Perspective
(Disease)
Drugs
Surgery
www.agitasp.org.br
Pharmacological Determinism
Surgery Determinism
www.agitasp.org.br
Building Health !
www.agitasp.org.br
Adjusted for age, smoking, and intakes of meat,
fish, fruits, and BMI
<5
5-14
15-24
25-34
35-44
Walking distance(km)
45+
<1.2
1.2-1.5
1.5-1.8
1.8-2.1
Walking speed (m/s)
*P<0.05, †P<0,01, ‡P<0,001, and §P<0,0001
WILLIAMS, P.T. Med.Sci.Sports Exerc. 40(3):433-443,2008
>2.1
EXER
“STENT” or PHYSICAL ACTIVITY SURVIVAL
EXERCISE
STENT
Building Health through
Physical Activity !
www.agitasp.org.br
Physical Activity
Diet
Mental Health
www.agitasp.org.br
Building Health through
Healthy Behaviors
www.agitasp.org.br
Healthy Behaviors
Physical Activity
Diet
Mental Health
(No Tabaco/ Alchool)
www.agitasp.org.br
Drugs
Surgery
Building Health
www.agitasp.org.br
The Vision
a
t
i
Ag o
d
n
Mu
Putting Theory and Practice in one Sentence !
SÃO PAULO STATE
BARRETOS
RIBEIRÃO PRETO
MARÍLIA
EMILIANOPÓLIS
PIRAPOZINHO
ASSIS
PRESIDENTE
PRUDENTE
Some Partners of
Agita São Paulo
BAURU
IPEÚNA
AMPARO
SANTANA
LIMEIRA
DO PARNAÍBA
Elias Fausto
OURINHOS
JACAREÍ
PIRACICABA
S.J.C.
CÂNDIDO MOTA
Sta. Cruz da Conceição
Population: 40 million
Area: 248.808. km2
SOROCABA
S.C.S CAPITAL
S.B.C.
DIADEMA
SANTOS
Cities: 645
ILHA BELA
SÃO SEBASTIÃO
“MOBILE MANAGEMENT” - ECOLOGICAL MODEL
INTRAPERSONAL
PHYSICAL
ENVIRONMENT
SOCIAL ENVIRONMENT
Cultural
Natural
Environment
`Constructed
Environment
Demographic
Social Climate
Recreation
Cognitive/
Affective
Geography
Architectural
Supportive
Behaviors
Biological
Information
Weather
Entertainment
Behavioural
Matsudo V et al, Perspectives 2004
Policies
Governing
Resources
Policies
Governing
Incentives
Urban
Suburban
Transport
“MOBILE MANAGEMENT” - ECOLOGICAL MODEL
INTRAPERSONAL
PHYSICAL
ENVIRONMENT
SOCIAL ENVIRONMENT
Demographic
Cognitive/
Affective
Cultural
Natural
Environment
`Constructed
Environment
Social Climate
Recreation
Geography
Information
Supportive
Behaviors
Biological
Architectural
Weather
Entertainment
Behavioural
Policies
Governing
Resources
Matsudo V et al, Perspectives 2004
Policies
Governing
Incentives
Urban
Suburban
Transport
Promoting PA in a World of Diversity
Traditional Partners
Health, Sports & Educational Sector
Non-Traditional Partners
New Players
(Marketing, Communication, Transport,
Urban Planning, Environment,
Economy, Management ...)
Partnership
Executive Board Meeting
THE TWO-HATS APPROACH
Government
NGOs &
Private Sector
AGITA BRASIL
Agita São Paulo
GO
PROGRAMA AGITA BRASIL
AMAPÁ
Clear Message !
At least 30 MINUTES / DAY
PHYSICAL ACTICITY
RECOMMENDATION
MOSTLY (5) DAYS
OF THE WEEK
Agita
Agita São
São Paulo
Paulo
CONTINUOUS OR
ACCUMULATED
MODERATE
CDC
CDC // ACSM
ACSM 96/2004
96/2004
a
Agit o
d
Mun
RAFA – PANA
REDE DE ATIVIDADE FÍSICA DAS AMÉRICAS
PHYSICAL ACTIVITY NETWORK of AMERICAS
Moderate PA
Works !
RISK OF DEATH X TOTAL ENERGY EXPENDITURE
RR
Kj.wk-1
RR
%
Gasto energético total
1
0,95
< 4200
1.0 referência
0
0.80
(0.72 – 0.88)
- 20
8400 <12600
0.74
(0.65 – 0.83)
- 26
12600 - <
16800
0.80
(0.69 – 0.93)
- 20
 16800
0.73
(0.64 – 0.84)
- 27
4200 <8400
p < 0,001
Observational Cohort Study
13.485 Men ; 2.539 Deathes
20%
0,9
27%
74%
0,85
26%
0,8
96%
0,75
0,7
<4200
4200 - <
8400
8400 - <
12600
12600 - <
16800
16800
Kj.wk-1
LEE et al., Am J Epidemiol, 2000