Why this case study?

This illustrates the importance of engaging different sectors for the scale up of effective interventions.

It also highlights challenges to scale up – such as changes in policies and funding mechanisms.

Title

Scaling up of physical activity interventions at the national level in Brazil: An effective solution to increase physical activity at the population level

Source

Washington University in St. Louis, St Louis, Missouri, United States of America

Health issue

Inadequate levels of physical activity and the need to address health disparities in the population of Brazil

Setting

Community (Brazil)

Target population

Brazil (adults and older adults from the general community)

Background

In Brazil, guidelines on physical activity suggest a minimum of 150 minutes of moderate or vigorous physical activity per week. However, the most recent national survey showed that nearly half the adult population did not reach this level of activity, with approximately 15% being completely inactive. The most commonly cited barriers to engaging in physical activity include lack of time and work/family responsibilities.

Project GUIA (Guide for Useful Interventions for Physical Activity in Brazil and Latin America)⁽³⁾ is a cross-national collaboration funded by the Prevention Research Centers programme (run by the Centers for Disease Control and Prevention (CDC)); it sets out to evaluate a programme taking place in Brazil for over a decade.⁽⁴⁾

Description of policy or intervention

The programme ‘Academia da Cidade’ or ‘City Gym’ started in Recife, Pernambuco in the north-east of Brazil, and was institutionalized in 2002. It is carried out at a number of points of intervention or so called polos – new spaces or re-engineered and beautified public spaces.

Physical and cultural activities are provided by professional instructors and include: dancing, aerobics, strength training, flexibility and other health enhancing activities.

What took place

In 2008, Project GUIA evaluated the Academia da Cidade programme using a combination of qualitative and quantitative methods including a phone survey, systematic direct observation, historical evaluation, logic models and qualitative interviews of coordinators, staff and users.^(5-9)

Results from the evaluation showed that the programme was effective in increasing and maintaining physical activity levels of the population and helped meet the guide- lines for physical activity.

The evaluation also assessed reach, showing that women, older adults, and lower in- come people were the segments of the population that benefited the most from the programme.⁽¹⁰⁾

What was learnt

Two significant events took place after results from the evaluation were shared with Project GUIA stakeholders:

1. In early 2011, the government of the state of Pernambuco created the Academias das Cidades de Pernambuco (ACP), a programme that aimed to expand the basic offering of Academia da Cidade.⁽¹¹⁾
2. Later in 2011, the ministry of health created the Academia da Saude (AS), a national programme with added nutritional and social development components.⁽¹¹⁾ Changes in the supportive policies and in the funding mechanisms have represented challenges for implementation at a large scale and for sustainability.

The experience and lessons learned in Brazil show the challenge of scaling up physical activity interventions and the need to consider long-term political and financial support.⁽¹¹⁾

References

1. Hoehner, C.M., et al., Physical activity interventions in Latin America: a systematic review. Am J Prev Med, 2008. 34(3): p. 224-233.
2. Hoehner, C.M., et al., Physical activity interventions in Latin America: expanding and classifying the evidence. Am J Prev Med, 2013. 44(3): p. e31-40.
3. Paez, D.C., et al., Bridging the gap between research and practice: an assessment of external validity of community-based physical activity programs in Bogota, Colombia, and Recife, Brazil. Transl Behav Med, 2015. 5(1): p. 1-11.
4. Pratt, M., et al., Project GUIA: A model for understanding and promoting physical activity in Brazil and Latin America. J Phys Act Health, 2010. 7 Suppl 2: p. S131-4.
5. Parra, D.C., et al., Assessing physical activity in public parks in Brazil using systematic observation. Am J Public Health, 2010. 100(8): p. 1420-6.
6. Simoes, E.J., et al., Effects of a community-based, professionally supervised intervention on physical activity levels among residents of Recife, Brazil. Am J Public Health, 2009. 99(1): p. 68-75.
7. Hallal, P.C., et al., Association between perceived environmental attributes and physical activity among adults in Recife, Brazil. J Phys Act Health, 2010. 7 Suppl 2: p. S213-22.
8. Hallal, P.C., et al., Evaluation of the Academia da Cidade program to promote physical activity in Recife, Pernambuco State, Brazil: perceptions of users and non-users. Cad Saude Publica, 2010. 26(1): p. 70-8.
9. Soares, J., et al., Cross-sectional associations of health-related quality of life measures with selected factors: a population-based sample in recife, Brazil. J Phys Act Health, 2010. 7 Suppl 2: p. S229-41.
10. Reis, R.S., et al., Assessing participation in community-based physical activity programs in Brazil. Med Sci Sports Exerc, 2014. 46(1): p. 92-8.
11. Parra, D.C., et al., Scaling up of physical activity interventions in Brazil: how partnerships and research evidence contributed to policy action. Glob Health Promot, 2013. 20(4): p. 5-12.