victor matsudo lighting the fire the brazil experience barbados march 6th, 2009 active caribbean...
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Victor Matsudo
LightingLighting thethe Fire Fire
The Brazil ExperienceThe Brazil Experience
Barbados
March 6th, 2009
Active Caribbean Workshop 2009
Road to the Wellness Revolution [email protected]
“The Samba – Caribbean Connection”.
It is not a Matter of What ;
But a Matter of How !
Time for Action; and for Revolution !
CELAFISCSCELAFISCS**** **** **
Center of Studies of the Physical FitnessResearch Laboratory - São Caetano do Sul Center of Studies of the Physical Fitness
Research Laboratory - São Caetano do Sul
Victor MatsudoScientific Director
Douglas R AndradePast-Vice-President
Sandra MatsudoGeneral Director
Erinaldo L de AndradeSecretary General
Timóteo L AraújoPresident
Gláucia F Braggion2nd Secretary
Luis C de OliveiraVice-President
CELAFISCS - Executive BoardCELAFISCS - Executive Board
CELAFISCS Family !
We have a dreamWe have a dream
- Agita São Paulo- Agita São Paulo - Agita São Paulo- Agita São PauloCELAFISCSCELAFISCSCELAFISCSCELAFISCS
Physical ActivityPhysical ActivityPhysical ActivityPhysical Activity
Caloric Intake Caloric Intake Caloric Intake Caloric Intake 3000 Kcal d-13000 Kcal d-1
2100 Kcal d-12100 Kcal d-11000 Kcal d-11000 Kcal d-1
300 Kcal d-1300 Kcal d-1
SubsistenceEfficiency
3:1
SubsistenceEfficiency
3:1
Subsistence Efficiency
7:1
Subsistence Efficiency
7:1
Pre-Industrial Pre-Industrial ContemporaryContemporary
International Association for the Study of Obesity, 2003International Association for the Study of Obesity, 2003
7,7 9,7
1822,3
37,9
69,3
0
10
20
30
40
50
60
70
Alcholism Diabetes Obesity Hypertension Tabagism Sedentarism
Prevalence of Risk Factors in São Paulo Prevalence of Risk Factors in São Paulo
Rego et al. Braz J Pub Health,1990Rego et al. Braz J Pub Health,1990
%%
8,3
1,3
12,7
6,5
21,5
7,2
31,5
18
0
10
20
30
40
MEN WOMEN
%
25% POOREST 25% 25% 25% RICHEST
Monteiro & Matsudo, Pan American Journal Public Health, 14(4):246-253,2003
Any Leisure-Time Physical Acitvity According to Socio-Economic Level
1 1,593,01
5,05
1
5,446,11
17,27
0
5
10
15
20
1st 2nd 3rd 4th
MEN
WOMENEducation
n: 11.033 – H: 5234 / M: 5799 – n: 11.033 – H: 5234 / M: 5799 – >> 20 anos 4.800 – Home-Interview 20 anos 4.800 – Home-Interview Monteiro C, Matsudo S, 2003Monteiro C, Matsudo S, 2003
Gender and Educational Level & Probability of engaging in any LTPA
OR
World deaths in 2000 attributable to selected leading risk factors
0 1000 2000 3000 4000 5000 6000 7000 8000
Occupational risk factors for injury
Unsafe health care injections
Vitamin A deficiency
Zinc deficiency
Urban air pollution
Iron deficiency
Indoor smoke from solid fuels
Unsafe water, sanitation, and hygiene
Alcohol
Physical inactivity
High Body Mass Index
Fruit and vegetable intake
Unsafe sex
Underweight
Cholesterol
Tobacco
Blood pressure
2 Million Deaths
Number of deaths (000s)
Sedentarism
WHO, 2005
Do Scientific Do Scientific Evidences Evidences
Change Change Behavior ?Behavior ?
Morris et al. 1953
Angina Incidence (1949-1950)
Cardio-vascular deathes
Total
HIP FRACTURE IN MEN BY CHANGE IN PHYSICAL ACTIVITY HIP FRACTURE IN MEN BY CHANGE IN PHYSICAL ACTIVITY BETWEEN 50 AND 60 YEARS OF AGEBETWEEN 50 AND 60 YEARS OF AGE
MICHAELSSON, K. et al.PLoS. Med. 4 (6):1094:1100,2007
Cu
mu
lati
ve P
erc
en
tag
e w
ith
Cu
mu
lati
ve P
erc
en
tag
e w
ith
Hip
Fra
ctu
re (
%)
Hip
Fra
ctu
re (
%)
6060 65 65 7070 75 75 80 85 9080 85 90
Age in YearsAge in Years
35 YEARS OF FOLLOW-UP
2.205 HOMENSBorn Between 1920 and 1924CohortUppsala Longitudinal Study of Adult Men (ULSAM)
1616
1212
88
44
00
Constant low or medium physical activity
Reduced from high to medium physical activity
Increased from low or medium to high physical activity
Constant high physical activity
2,34 (1,41-3,88)
1,92 (1,07-3,42)
1,44 (0,76-2,74)
1 reference
0
1
2
3
HA
ZA
RD
RA
TIO
S
High Medium Low
PHYSICAL ACTIVITY
1Ref.
1,65(1,13-2,41)
2,65(1,55-4,24)
PHYSICAL ACTIVITY AND HIP PHYSICAL ACTIVITY AND HIP FRACTURE IN MENFRACTURE IN MEN
35 YEARS OF FOLLOW-UP
MICHAELSSON, K. et al.PLoS. Med. 4 (6):1094:1100,2007
2.205 HOMENSBorn Between 1920 and 1924CohortUppsala Longitudinal Study of Adult Men (ULSAM)
0
0,5
1
0 MET -h/wk 0 - 8.9 MET -h/wk > 9 MET h/wkAdjusted for Age
Adjusted for age, race, disease stage, initial treatment, tamoxifen use, body mass index, and fruit/vegetable servings per day
P for Trend = 0.014
Har
zad
Rat
ios
Associations Between Breast Cancer Outcomes and Physical Activity 2 Years After Diagnosis
0.21
- 0
.78
0.15
- 0
.61
0.17
- 0
.73
0.15
- 0
.73
P for Trend = 0.046
Irwin et al, J Clin Oncol 26:3958-3964, 2008933 women x Age= 55.5
59%70% 64%
67%
(0.46 – 0.98) (0.49 – 0.95) (0.47 – 0.89) (0.44 – 0.87)Ref.
Rel
ati
ve
Ris
k
Physical Activity (Times / Week
LEITZMANN MF et al.Am. J. Preventive Medicine 2009; 36(2) :112-119
Relative Risk of Gastric and Esophagic Carcinoma Relative Risk of Gastric and Esophagic Carcinoma According to Physical ActitivtyAccording to Physical Actitivty
Cohort 487.732 Homens e Mulheres50 a 71 Anos de Idade8 Anos de Seguimento523 Casos de Carcinoma Esofágico642 Casos de Carcinoma Gástrico
NIH – AARP Diet and Health Study
- 38%
p for trend 0,024Noncardia Gastric Adenocarcinoma
Total: 8940
10 years: 5284 5 years: 3224 last yr: 645
Humans: 777410 years: 4646 5 years: 2814 last yr: 511
Bergamaschi, J. May 30th, 2007
Publications on P.A.& CVD
Matsudo, V Sea Pines Course, 2003Matsudo, V Sea Pines Course, 2003
70 801960
Physical Activity
90 2000
Published Papers
Physical Activity Academic Physical Activity Academic ParadoxParadox
Worst than a Tragedy is
Not to Learn with the Tragedy !
Free Thinking…
www.agitasp.org.brwww.agitasp.org.br
Medical Medical PerspectivePerspective(Disease)(Disease)
Medical Medical PerspectivePerspective(Disease)(Disease)
DrugsDrugsDrugsDrugs SurgerySurgerySurgerySurgery
www.agitasp.org.brwww.agitasp.org.br
Pharmacological DeterminismPharmacological DeterminismPharmacological DeterminismPharmacological Determinism
Surgery DeterminismSurgery DeterminismSurgery DeterminismSurgery Determinism
www.agitasp.org.brwww.agitasp.org.br
Building Health ! Building Health !
WILLIAMS, P.T. Med.Sci.Sports Exerc. 40(3):433-443,2008
Adjusted for age, smoking, and intakes of meat, fish, fruits, and BMI
*P<0.05, †P<0,01, ‡P<0,001, and §P<0,0001
<5 5-14 15-24 25-34 35-44 45+
Walking distance(km)<1.2 1.2-1.5 1.5-1.8 1.8-2.1 >2.1
Walking speed (m/s)
EXER
STENT
“STENT” or PHYSICAL ACTIVITY SURVIVAL
EXERCISE
www.agitasp.org.brwww.agitasp.org.br
Building Health throughBuilding Health through Physical Activity !Physical Activity !
www.agitasp.org.brwww.agitasp.org.br
Mental HealthMental Health
DietDietPhysical ActivityPhysical Activity
www.agitasp.org.brwww.agitasp.org.br
Building Health through Building Health through Healthy BehaviorsHealthy Behaviors
www.agitasp.org.brwww.agitasp.org.br
Healthy BehaviorsHealthy BehaviorsHealthy BehaviorsHealthy Behaviors
Physical ActivityPhysical Activity
DietDiet
Mental Health Mental Health
(No Tabaco/ Alchool) (No Tabaco/ Alchool)
Physical ActivityPhysical Activity
DietDiet
Mental Health Mental Health
(No Tabaco/ Alchool) (No Tabaco/ Alchool)
www.agitasp.org.brwww.agitasp.org.br
Building HealthBuilding Health
Surgery Surgery DrugsDrugs
The VisionThe Vision
Putting Theory and Practice in one Sentence !
PIRACICABA
ILHA BELA
ASSIS
SÃO SEBASTIÃO
AMPARO
S.C.S
PRESIDENTEPRUDENTE
LIMEIRA
SOROCABA
SANTOS
MARÍLIA
S.B.C.DIADEMA
SANTANADO PARNAÍBA
JACAREÍS.J.C.
CAPITAL
BARRETOS
RIBEIRÃO PRETO
BAURU
CÂNDIDO MOTA
PIRAPOZINHOEMILIANOPÓLIS
OURINHOS
Sta. Cruz da Conceição
Elias Fausto
IPEÚNA
SÃO PAULO STATE
Population: 40 million
Area: 248.808. km2248.808. km2
Cities: Cities: 645645
Population: 40 million
Area: 248.808. km2248.808. km2
Cities: Cities: 645645
Some Partners of Agita São Paulo
Supportive
Behaviors
Supportive
Behaviors
SOCIAL ENVIRONMENTINTRAPERSONAL
`ConstructedEnvironment`ConstructedEnvironment
TransportTransportTransportTransport
ArchitecturalArchitectural ArchitecturalArchitectural
UrbanUrbanSuburbanSuburban
UrbanUrbanSuburbanSuburban
BiologicalBiological
PoliciesGoverning Resources
PoliciesGoverning Resources
PoliciesGoverningIncentives
PoliciesGoverningIncentives
DemographicDemographic
“MOBILE MANAGEMENT” - ECOLOGICAL MODEL
PHYSICAL ENVIRONMENT
NaturalEnvironment
NaturalEnvironment
Cognitive/Affective
Cognitive/Affective
CulturalCultural
Social ClimateSocial Climate
InformationInformationInformationInformationGeographyGeographyGeographyGeography
WeatherWeatherWeatherWeather
EntertainmentEntertainmentEntertainmentEntertainment
RecreationRecreationRecreationRecreation
Matsudo V et al, Perspectives 2004
BehaviouralBehavioural
Supportive
Behaviors
Supportive
Behaviors
SOCIAL ENVIRONMENT
INTRAPERSONAL
`ConstructedEnvironment`ConstructedEnvironment
TransportTransportTransportTransport
ArchitecturalArchitectural ArchitecturalArchitectural
UrbanUrbanSuburbanSuburban
UrbanUrbanSuburbanSuburban
BiologicalBiological
PoliciesGoverning Resources
PoliciesGoverning Resources
PoliciesGoverningIncentives
PoliciesGoverningIncentives
DemographicDemographic
“MOBILE MANAGEMENT” - ECOLOGICAL MODEL
PHYSICAL ENVIRONMENT
NaturalEnvironment
NaturalEnvironmentCognitive/
AffectiveCognitive/Affective CulturalCultural
Social ClimateSocial Climate
InformationInformationInformationInformationGeographyGeographyGeographyGeography
WeatherWeatherWeatherWeather
EntertainmentEntertainmentEntertainmentEntertainment
RecreationRecreationRecreationRecreation
Matsudo V et al, Perspectives 2004Matsudo V et al, Perspectives 2004
BehaviouralBehavioural
Traditional PartnersTraditional Partners
Health, Sports & Educational SectorHealth, Sports & Educational Sector
Non-Traditional PartnersNon-Traditional Partners
New PlayersNew Players
(Marketing, Communication, (Marketing, Communication,
Transport, Transport, Urban Planning, Urban Planning,
Environment, Environment,
Economy, Management ...)Economy, Management ...)
Promoting PA in a World of Diversity
Partnership Executive Board Meeting
GovernmentGovernmentGovernmentGovernment NGOs &NGOs &
Private SectorPrivate Sector
NGOs &NGOs &
Private SectorPrivate Sector
AGITA AGITA
BRASILBRASIL
AGITA AGITA
BRASILBRASILAgita São PauloAgita São Paulo
THE TWO-HATS APPROACHTHE TWO-HATS APPROACH
AMAPÁLOGO PROGRAMA AGITA BRASIL
Clear Message !Clear Message !
Agita
MundoAgita
Mundo
RAFA – PANAREDE DE ATIVIDADE FÍSICA DAS AMÉRICASPHYSICAL ACTIVITY NETWORK of AMERICAS
PHYSICAL ACTI CITYRECOMMENDATI ONPHYSICAL ACTI CITYPHYSICAL ACTI CITYRECOMMENDATI ONRECOMMENDATI ON
At least 30 MI NUTES / DAYAt At leastleast 30 MI NUTES / DAY30 MI NUTES / DAY
MOSTLY (5) DAYSOF THE WEEK
MOSTLY MOSTLY (5)(5) DAYSDAYSOF THE WEEKOF THE WEEK
CONTI NUOUS ORACCUMULATED
CONTI NUOUSCONTI NUOUS ORORACCUMULATEDACCUMULATED
CDC / ACSM 96/ 2004CDC / ACSM 96/ 2004CDC / ACSM 96/ 2004MODERATEMODERATEMODERATEAgita São PauloAgita São Paulo
Moderate PA Moderate PA Works !Works !
RISK OF DEATH X TOTAL ENERGY EXPENDITURE
0,7
0,75
0,8
0,85
0,9
0,95
1
<4200 4200 - <8400
8400 - <12600
12600 - <16800
16800
Gasto energético total
Kj.wk-1
RR
20%
Kj.wk-1 RR %
< 4200 1.0 referência 0
4200 - <8400
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
168000.73
(0.64 – 0.84)- 27
LEE et al., Am J Epidemiol, 2000
p < 0,001
27%74%
26% 96%
Observational Cohort Study 13.485 Men ; 2.539 Deathes