Abstract

Objective

to analyze sociodemographic variables associated with insufficient physical activity level in Bahian quilombolas.

Methods

this was a cross-sectional study with data on sociodemographic characteristics and level of physical activity using a standardized form, administered through interviews with a representative sample of adults living in quilombos in the geographical region of Bahia; crude and adjusted logistic regression was used.

Results

850 participants were included whose average age was 45.0+17.0 years; 61.2% were female; prevalence of physical inactivity was 21.9% (95%CI 19.1; 24.7); insufficient physical activity level among adult quilombolas was higher among the elderly (OR 2.12; 95%CI 1.29; 3.49) and individuals who did not work (OR 1.47; 95%CI 1.01; 2, 14).

Conclusion

being elderly and not working is associated with insufficient physical activity in quilombolas.

African Continental Ancestry Group; Motor Activity; Health Surveys

Introduction

Chronic noncommunicable diseases (NCDs) are the leading set of prevalent diseases and causes of death among the different socio-economic segments of the population.¹2. Theme Filha MM, Souza Junior PRB, Damacena GN, Szwarcwald CL. Prevalência de doenças crônicas não transmissíveis e associação com auto avaliação de saúde: Pesquisa Nacional de Saúde, 2013. Rev Bras Epidemiol [Internet]. 2015 dez [citado 2020 maio 19];18(supl.2):83-96. Disponível em: http://dx.doi.org/10.1590/1980-5497201500060008
http://dx.doi.org/10.1590/1980-549720150... In 2011, these diseases were responsible for the deaths of more than 850,000 Brazilians, corresponding to 72.7% of deaths recorded on the Mortality Information System (SIM).³4. Boccolini CS, Souza Junior PRB. Inequities in healthcare utilization: results of the Brazilian National Health Survey, 2013. Int J Equity Health [Internet]. 2016 Nov [cited 2020 May19];15(150). Available from: https://doi.org/10.1186/s12939-016-0444-3
https://doi.org/10.1186/s12939-016-0444-...

Diverse factors can influence reduced occurrence of NCDs among the Brazilian population.⁴5. Perdersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports [Internet]. 2015 Dec [cited 2020 May 19];25(Suppl. 3):1-72. Available from: https://doi.org/10.1111/sms.12581
https://doi.org/10.1111/sms.12581... In this sense, doing physical activity (PA) is an important behavior that impacts on primary prevention and/or treatment of diverse chronic diseases,⁵6. Lee I, Shiroma EJ, Alkandari JR, Andersen LB, Bauman A, Blair SN, et al. Impact of physical inactivity on the world’s major non-communicable diseases. Lancet [Internet]. 2012 Jul [cited 2020 May 19];380(9838):219-29. Available from: https://dx.doi.org/10.1016%2FS0140-6736(12)61031-9
https://dx.doi.org/10.1016%2FS0140-6736(... and adopting a physically active lifestyle reduces NCD occurrence by 6% to 10%.⁶7. World Health Organization - WHO. Global recommendations on physical activity for health [Internet]. Geneva: World Health Organization; 2010 [citado 2017 Jun]. 58 p. Available from: http://apps.who.int/iris/bitstream/10665/44399/1/9789241599979_eng.pdf
http://apps.who.int/iris/bitstream/10665...

Regular PA is directly related to improved and/or continuing good health in people of all ages,⁷8. Reimers CD, Knapp G, Reimers AK. Does physical activity increase life expectancy? A review of the literature. J Aging Res [Internet]. 2012 [cited 2020 May 19];243958. Available from: https://dx.doi.org/10.1155%2F2012%2F243958
https://dx.doi.org/10.1155%2F2012%2F2439... and is inversely associated with different health risk factors (increased blood pressure, lipid and blood glucose levels), reducing premature mortality from all causes by around 30% to 35%.⁸9. Katzmarzyk PT, Lee IM, Martin CK, Blari SN. Epidemiology of physical activity and exercise training in the United States. Prog Cardiovasc Dis [Internet]. 2017 Jun-Jul [cited 2020 May 19];60(1):3-10. Available from: https://doi.org/10.1016/j.pcad.2017.01.004
https://doi.org/10.1016/j.pcad.2017.01.0...

However, assessing PA level (PAL) still raises methodological issues that hinder its measurement in representative samples of the population.⁹10. Sesso HD. Invited commentary: a challenge for physical activity epidemiology. Am J Epidemiol [Internet]. 2007 Jun [cited 2020 May 19];165(12):1351-53. Available from: https://doi.org/10.1093/aje/kwm093
https://doi.org/10.1093/aje/kwm093... The main difficulty consists of divergence as to a universally standardized technique for measuring the diverse domains of PAL.¹⁰11. Troiano RP. A timely meeting: objective measurement of physical activity. Med Sci Sports Exerc [Internet]. 2005 Nov [cited 2020 May 19];37(11):S487-9. Available from: https://doi.org/10.1249/01.mss.0000185473.32846.c3
https://doi.org/10.1249/01.mss.000018547...

Questionnaires are among the instruments widely used to determine PAL in population-based epidemiological studies, due to the ease and low cost of administering them. As such, the International Physical Activity Questionnaire (IPAQ) has been widely used in studies worldwide.¹²13. Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U, et al. Global physical activity levels: surveillance progress, pitfalls and prospects. Lancet [Internet]. 2012 Jul [cited 2020 May 19];380(9838):247-57. Available from: https://doi.org/10.1016/s0140-6736(12)60646-1
https://doi.org/10.1016/s0140-6736(12)60...

High prevalence rates of insufficient practice of PA have been found in different populations and are present in around 23% of adults 18 years old,⁷8. Reimers CD, Knapp G, Reimers AK. Does physical activity increase life expectancy? A review of the literature. J Aging Res [Internet]. 2012 [cited 2020 May 19];243958. Available from: https://dx.doi.org/10.1155%2F2012%2F243958
https://dx.doi.org/10.1155%2F2012%2F2439... so that globally it is the fourth leading mortality risk factor. In the Brazilian state capitals, 13.7% of adults are insufficiently physically active, especially females and people with lower schooling levels.¹⁴15. Bicalho PG, Hallal PC, Gazzinelli A, Knuth AG, Velásquez-Meléndez G. Atividade física e fatores associados em adultos de área rural em Minas Gerais, Brasil. Rev Saúde Publica [Internet]. 2010 out [citado 2020 maio 19];44(5):884-93. Disponível em: https://doi.org/10.1590/S0034-89102010005000023
https://doi.org/10.1590/S0034-8910201000...

PAL is also subject to environmental influences. Those who live in rural communities are seen to adhere more to global recommendations on PA; research¹⁵16. Pegorari MS, Dias FA, Santos NMF, Tavares DMS. Práticas de atividade física no lazer entre idosos de área rural: condições de saúde e qualidade de vida. Rev Educ Fis UEM [Internet]. 2015 jun [citado 2020 maio 19];26(2):233-41. Disponível em: https://doi.org/10.4025/reveducfis.v26i2.25265
https://doi.org/10.4025/reveducfis.v26i2... suggests that this disparity could be related to the structural conditions imposed on these people (geographic isolation; restricted access to health services, education, transport services and income).

A study with surviving quilombo (settlements originally formed by escaped slaves) communities in the north of Minas Gerais state identified that 63% did less PA than is recommended for ensuring health benefits.¹⁷18. Bezerra VM, Andrade ACS, Cesar CC, Caiaffa WT. Domínios de atividade física em comunidades quilombolas do sudoeste da Bahia, Brasil: estudo de base populacional. Cad Saúde Pública [Internet]. 2015 jun [citado 2020 maio 19];31(6):1213-24. Disponível em: https://doi.org/10.1590/0102-311X00056414
https://doi.org/10.1590/0102-311X0005641... A study with quilombolas (maroons) in a municipality in the southeast of Bahia state indicated that they are more active when at work than in their free (or leisure) time, scoring 42.1% and 13.1%, respectively.¹⁸19. Mussi RFF, Mussi LMPT, Bahia CS, Amorim AM. Atividades físicas praticadas no tempo livre em comunidade quilombola do alto sertão baiano. Licere [Internet]. 2015 mar [citao 2020 maio 19];18(1):157-87. Disponível em: https://doi.org/10.35699/1981-3171.2015.1080
https://doi.org/10.35699/1981-3171.2015.... Mussi et al.¹⁹20. Mielke GI, Hallal PC, Rodrigues GBA, Szwarcwald CL, Santos FV, Malta DC. Prática de atividade física e hábito de assistir à televisão entre adultos no Brasil: Pesquisa Nacional de Saúde 2013. Epidemiol. Serv. Saúde, [Internet]. 2015 abr-jun [citado 2020 maio 19]; 24(2): 277-286. Disponível em: https://doi.org/10.5123/S1679-49742015000200010
https://doi.org/10.5123/S1679-4974201500... also identified a low amount of PA in the free time of a Bahian quilombola community living on the banks of the São Francisco river.

Despite the recognized benefits for health of practicing PA,⁵6. Lee I, Shiroma EJ, Alkandari JR, Andersen LB, Bauman A, Blair SN, et al. Impact of physical inactivity on the world’s major non-communicable diseases. Lancet [Internet]. 2012 Jul [cited 2020 May 19];380(9838):219-29. Available from: https://dx.doi.org/10.1016%2FS0140-6736(12)61031-9
https://dx.doi.org/10.1016%2FS0140-6736(... research with quilombolas has indicated low PA levels.¹⁷18. Bezerra VM, Andrade ACS, Cesar CC, Caiaffa WT. Domínios de atividade física em comunidades quilombolas do sudoeste da Bahia, Brasil: estudo de base populacional. Cad Saúde Pública [Internet]. 2015 jun [citado 2020 maio 19];31(6):1213-24. Disponível em: https://doi.org/10.1590/0102-311X00056414
https://doi.org/10.1590/0102-311X0005641... However, considering local,¹⁹20. Mielke GI, Hallal PC, Rodrigues GBA, Szwarcwald CL, Santos FV, Malta DC. Prática de atividade física e hábito de assistir à televisão entre adultos no Brasil: Pesquisa Nacional de Saúde 2013. Epidemiol. Serv. Saúde, [Internet]. 2015 abr-jun [citado 2020 maio 19]; 24(2): 277-286. Disponível em: https://doi.org/10.5123/S1679-49742015000200010
https://doi.org/10.5123/S1679-4974201500... municipal¹⁸19. Mussi RFF, Mussi LMPT, Bahia CS, Amorim AM. Atividades físicas praticadas no tempo livre em comunidade quilombola do alto sertão baiano. Licere [Internet]. 2015 mar [citao 2020 maio 19];18(1):157-87. Disponível em: https://doi.org/10.35699/1981-3171.2015.1080
https://doi.org/10.35699/1981-3171.2015.... and regional¹⁷18. Bezerra VM, Andrade ACS, Cesar CC, Caiaffa WT. Domínios de atividade física em comunidades quilombolas do sudoeste da Bahia, Brasil: estudo de base populacional. Cad Saúde Pública [Internet]. 2015 jun [citado 2020 maio 19];31(6):1213-24. Disponível em: https://doi.org/10.1590/0102-311X00056414
https://doi.org/10.1590/0102-311X0005641... samples, availability of information on its negative impacts on the health of the quilombola population is still limited. As such, this study seeks to analyze sociodemographic variables associated with insufficient PAL among Bahian quilombolas.

Methods

This analysis is part of the population-based cross-sectional study entitled “Epidemiological Profile of Bahian Quilombolas”, conducted between February and November 2016.

The empirical field is the geographical region of Guanambi, Bahia, which had 42 certified contemporary quilombos in 2016, distributed over ten municipalities. In view of no prior official information being available as to the number of people living in the quilombos of this Bahian microregion, the population was estimated assuming 80 families per quilombo, with two adults (>18 years old) per family in each community, totaling 6,720 adults.

The sample size calculation considered: finite population correction, 46% outcome prevalence²⁰21. Matsudo S, Araújo T, Matsudo V, Andrade D, Andrade E, Oliveira LC, et al. Questionário Internacional de Atividade Física (IPAQ): um estudo de validade e reprodutibilidade no Brasil. Rev Bras Ativ Fís Saúde [Internet]. 2001 [citado 2020 maio 20];6(2):5-18. Disponível em: https://doi.org/10.12820/rbafs.v.6n2p5-18
https://doi.org/10.12820/rbafs.v.6n2p5-1... (<150 minutes of PA a week considering the following domains: leisure; work; domestic/household; and movement between one place and another), 95% confidence interval, sample error of 5 percentage points (p.p.), 1.5 times effect for conglomerates, additional 30% for refusals and 20% for losses and confounders, resulting in a sample size of 813 subjects.

The sample design had two stages: random selection of the quilombos (conglomerates) and, following this, census gathering. Initially the quilombos were selected randomly. Through their respective residents’ associations, 14 of the selected units allowed visits for the study to be conducted, while three refused to take part.

Considering all the adults in the eligible quilombos, the residents’ associations stated that there were 1,025 adults living there during the collection period. They were all invited and were informed about the aspects of the study, ensuring equal probability of participation (Figure 1).

Individuals with cognitive disabilities or unable to communicate independently were excluded from the interviews. Those who were bedridden, had amputated limbs, limbs in plaster, pregnant and breastfeeding mothers (up to six months after childbirth) were excluded from the anthropometric measurements. Losses were defined as a measurement or examination not being performed or an unanswered interview question.

Data collection took place by means of interviews, conducted by teams comprised of health professionals and/or undergraduates according to their qualifications, after having been trained. Data collection was done in mass at weekends and on public holidays.

The dependent variable, PA level, was determined in accordance with the International Physical Activity Questionnaire (IPAQ short version).²¹22. Oliveira-Campos M, Maciel MG, Rodrigues Neto JF. Atividade física insuficiente: fatores associados e qualidade de vida. Rev Bras Ativ Fis Saúde [Internet]. 2012 [citado 2020 maio 19];17(6):562-72. Disponível em: https://doi.org/10.12820/rbafs.v.17n6p562-572
https://doi.org/10.12820/rbafs.v.17n6p56... IPAQ classification was done in a binary manner, whereby individuals classified as being “very active” and/or “active” were grouped together as “active”; and individuals classified as being “irregularly active” and/or “inactive” were grouped together as “insufficiently active”.²²23. Malta DC, Andrade SSCA, Stopa SE, Pereira CA, Szwarcwald CL, Silva Júnior JB, et al. Estilos de vida da população brasileira: resultados da Pesquisa Nacional de Saúde, 2013. Epidemiol Serv Saúde [Internet]. 2015 abr-jun [citado 2020 maio 19];24(2):217-26. Disponível em: https://doi.org/10.5123/S1679-497420150002000004
https://doi.org/10.5123/S1679-4974201500...

The sociodemographic variables were: sex (female, male), age group (adults=18-59 years; elderly= 60 years or over), marital status (married; separated/divorced; widowed and single), literate (yes, no), family income (<1 minimum wage, ≥ 1 minimum wage), currently working (yes, no), religious affiliation (yes, no).

The population studied was characterized according to the absolute and relative frequencies of the sociodemographic, lifestyle and PA status variables.

Odds ratios (OR) were estimated based on logistic regression to analyze association between predictors and PAL. Crude ORs were checked initially. Variables with a p-value <0.20 were included in the adjusted analysis. A 5% significance level was used. All the analyses were performed using the Statistical Package for Social Sciences (SPSS), version 22.0.

The project was submitted to the Bahia State University Human Research Ethics Committee on 09/01/2016, and was approved as per Opinion No. 1.386.019/2016. All participants signed a Free and Informed Consent form.

Results

The final sample was comprised of 850 quilombolas who attended the activities and agreed to take part in the study, either by signing or putting their fingerprint on the individual Free and Informed Consent form (Figure 1). Refusals accounted for 17% of those who were invited, but did not attend the activities. Mean age of the participants was 45.0 (±17.0) years; 61.2% were female; 80.6% were adults; 74.6% were in a marital relationship; 71.9% were literate; 49.1% were currently working; and 79.0% had family income below the minimum wage (Table 1).

With regard to PAL, 21.9% (95%CI 19.1;24.7) were classified as being insufficiently active. Insufficiently active lifestyle was associated with participants’ age group, literacy and work (Table 2).

The binary logistic regression analyses indicated that being elderly (OR=2.67; 95%CI 1.83;3.89), illiterate (OR=1.47; 95%CI 1.03;2.10) and not working (OR=1.90; 95%CI 1.35;2.68) were associated with an insufficiently active lifestyle (Table 3).

Variables with p<0.20 in the crude analysis (age group; literacy; family income; currently working; and having religious affiliation were included in the adjusted analysis. Insufficient PA level among adult quilombolas remained associated with the elderly age group (OR=212; 95%CI 1.29; 3.49) and with those who were not working (OR=1.47; 95%CI 1.01; 2.14) (Table 3).

References

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