RESEARCH ARTICLES

Physical activity profile of family health strategy users

Claudia Santos Martiniano^I; Sabrina Talita Teotônio Bezerra^II; Karla Karolline Barreto Cardins^III; Larissa Nayane Braz do Nascimento^IV; Francisco de Sales Clementino^V; Cyrus Dalva da Silveira Barros^VI

^I Nurse. PhD in Health Sciences. Professor at the Nursing Department of the State University of Paraíba. Campina Grande, Paraíba, Brazil. E-mail: cmartiniano@ibest.com.br
^II Nurse. Specialist in Occupational Health Nursing. Campina Grande, Paraíba, Brazil. E-mail: sabrina_talita@msn.com
^III Nurse. Master Student of the Graduate Program in Public Health at the State University of Paraíba. Campina Grande, Paraíba, Brazil. E-mail: karla_karolline@hotmail.com
^IV Nurse. Specialist in Family Health. Campina Grande, Paraíba, Brazil. Email: larissanayaneb@gmail.com
^V Nurse. PhD in Nursing. Professor at the Nursing Department of the Federal University of Campina Grande. Campina Grande, Paraíba, Brazil. E-mail: fclementino67@yahoo.com.br
^VI Doctor of the Family Health Strategy. Campina Grande, Paraíba, Brazil. E-mail: cyrusdalva@hotmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2015.4013

ABSTRACT

This exploratory, descriptive case study evaluated the physical activity profile of family health strategy users between October 2010 and February 2011. At interview of 386 users over 20 years old, at a family health primary care facility in Campina Grande, Paraíba, 275 (71.24%) said they did no exercise, while 111 (28.76%) exercised. Adherence to physical activity was greater among users with higher education. Of participants who did physical exercise, 91 (101%) walked, 62 (55.88%) exercised three times a week, and 80 (72.03%) exercised for 30 to 60 minutes. It was concluded that physical activity is not habitual among users, and should be encouraged by the health team.

Keywords: Physical activity; health promotion; family health strategy; disease prevention.

INTRODUCTION

Physical activity has been present since the dawn of humanity, and, according to the story of its origin, we realize its presence from the prehistoric period in which the man for humankind survival accomplished hunts, races and fights, that is, was physically active. With the evolution of man, physical activity began to be performed in the form of exercise, a fact that was evident in Ancient Greece, with accounts of the history, training for war and gladiators, Olympic Games, among others. Early in the Contemporary Age, physical activity arose in Europe in the form of dance, games and gymnastics ¹.

From these practices, various methods of physical exercise at various locations around the world, such as Brazil, have been developed and had its beginning through medical guidelines, enhancing a healthy individual, providing them with a good physical appearance and improving their posture¹.

Although studies demonstrate that physical activity is essential for a healthy lifestyle, improving the quality of life and reducing the rates of chronic diseases^2-5, it is known that over 60% of adults worldwide do not perform physical exercises on a regular basis⁶.

This is the result of a new lifestyle, in which people, by the need to fit in the contemporary world way of life, are in constant search for professional improvement, trying to achieve better working conditions and salary. As a consequence, the time they have to perform extra activities has not been occupied by physical exercise, because as jobs are stressful, activities that provide relaxation are preferable, such as watching television, going out with family, surfing the internet or, simply resting⁷. Thus, it can be inferred that the lack of time is the main failure factor in the adoption of a regular model of exercises⁸. For this reason, physical inactivity has been considered a risk factor, together with smoking, diabetes, hypertension and dyslipidemia⁹.

By definition, physical activity is any movement produced as a result of muscular contraction that results in energy expenditure and alterations of the body, through exercises involving body motions, with application of one or more physical abilities and also mental and social activities, so that it will result in benefits to health¹⁰. Physical activity can be classified into aerobic and anaerobic; the first is of low resistance and the latter, of high resistance. Both cause low blood pressure, however, aerobic activity is recommended because both the acute and chronic effect in post-activity pressure is more intense this type of activity¹¹.

A sedentary lifestyle alters the quality of life of individuals and together with other factors it can have harmful effects on their health conditions, such as the increased incidence of diabetes and heart disease, thus contributing to the increase in morbidity and mortality from chronic diseases ⁹. There is also a positive relationship between physical activity and sleep, and the practice of the first is a favorable factor for improving the quality of the latter ¹².

Therefore, physical activity brings biopsychosocial benefits and involves the human being as a whole, providing a general welfare of the individual, acting both in disease prevention and in the treatment and control of certain diseases, especially chronic ones⁴.

It is vital that the Family Health Strategies (FHS) organize stimulus actions to bodily practices to the population, and that these actions are inserted where they do not yet exist. In this sense, this research aims to answer the following question: what is the profile of physical activity among users of Basic Family Health Unit (BFHU) of Maldivas I neighborhood?

Considering the importance of physical exercise for health, it is important to conduct research aimed at identifying the physical activity patterns of the community, so that we can establish links between them and the probable correlation between them and health problems, and also with a view to implementation of the Política Nacional de Promoção da Saúde (Health Promotion National Policy) as an important strategy to improve the population's quality of life, and the aim of this study was to evaluate the physical activity profile of the FHS users.

LITERATURE REVIEW

Studies have shown that people who keep their bodies in shape by using means of exercises and weight control have the benefit of prolonging life. Especially from 50 to 70 years old, studies have shown that mortality was three times lower in people who were fit, and the reasons for this are: keeping fit and controlling weight greatly reduces coronary heart disease because it results in maintaining the pressure below the normal level borderline (140/90 mm Hg) and reduces levels of total cholesterol and low density lipoproteins, as well as increases high density lipoproteins. These changes together help reducing the number of heart attacks and strokes¹³.

In addition to the reasons already mentioned, the practice of exercises provides increased body reserves that can be used when the body gets sick. This is important for the preservation of life when older people develop some disease such as pneumonia, which can quickly demand all respiratory reserve available. Furthermore, the ability to increase the cardiac output when it is needed is often 50% higher in elderly who are fit¹³.

Several institutions and organizations such as the International Federation of Sports Medicine, the American Heart Association, the World Health Organization (WHO) and the American College of Sports Medicine have emphasized the importance of adopting regular physical activity to improve individual and collective health levels, especially for prevention and rehabilitation of cardiovascular disease¹⁴.

The benefits of physical activities are not limited to physical health but also cover mental health, helping in the regulation of substances related to the nervous system, improve blood flow to the brain as well as the ability to deal with problems and stress, and also help maintaining the drug abstinence and recovery of self-esteem and treatment of depression ⁶.

In the social context of the individual, it improves relations both in the workplace and in the family. Among the many benefits it provides for health, physical activity has been considered as a way to benefit the functional capabilities of all people who practice it⁶.

According to the WHO, participation in light and moderate exercise can also retard the functional decline. Thus, an active life improves mental health and contributes to manage disorders like depression and dementia¹⁵.

The prevalence of physical inactivity among the prevalence of risk factors associated with hypertension is an eloquent demonstration of the importance of physical exercises, especially in the less marked elevations of blood pressure without damage to target organs and comorbidities such as diabetes mellitus or kidney diseases. Under these conditions, the strategy of changing lifestyle is the preferred procedure for hypertension approach⁶.

In this regard, we highlight the need for recommendation of physical activity by health professionals in order to prevent and control diseases and avoid the risk of death from heart problems and to promote improvement in people's quality of life⁴.

Physical exercises interfere in lowering blood pressure by the involvement of hemodynamic, humoral and neural factors⁶. The antihypertensive effect of exercise is a result of neuro-humoral, vascular and structural adjustments, resulting in decreased peripheral vascular resistance, such as lower production of catecholamines and improvement in insulin sensitivity, attenuation of α-adrenergic response to norepinephrine, change in production the local vasoconstrictor and vasodilator and vascular and remodeling and angiogenesis¹⁶.

Research on physical inactivity should compose the evaluation of the hypertensive population, and fighting against it is one of the measures indicated to reduce cardiovascular risk. It is estimated that sedentary individuals have an increased risk from 20% to 50% of developing hypertension¹¹.

The benefit of physical activity in normotensive population is the primary prevention of hypertension; it is also observed an improvement in the lipid profile and the feeling of physical well-being in people who have a regular physical activity. Physical activity is so important to health promotion that its inverse practice - physical inactivity - can be considered a public health problem.

In this sense, activities such as prescription of exercise, playful practices, sports and leisure must be present in the basic health network, being directed both to the community as a whole and for vulnerable groups¹². So, incorporating healthy practices that can bring benefits to the population is one of the challenges imposed to the entire structure of primary health care.

METHODOLOGY

We carried out descriptive and quantitative study, which had as empirical field the BFHU of Maldivas I neighborhood, in the city of Campina Grande-PB, which has two family health teams.

The population was composed by the registered users of the unit who were over 20 years of age since individuals under this age group mostly practice physical activity at school. Inclusion criteria were: users of the coverage area of BFHU Malvinas I and who are older than 20 years old. Users who fulfilled at least one of the following exclusion criteria did not participated in the research: being physically impaired person who possessed limitations for performing physical activity; being bedridden or unable to walk; and being under 20 years old.

In a previous survey, it was observed that in the first team there was a total of 1210 users and in the team 2 a total of 938 users in these conditions, therefore, we made a statistical sample establishing a confidence index of 95% and a margin of error of 5% in each stratum, which meant that 292 users were investigated in team 1 and 273 users in team 2. The selection of these users was performed randomly by lot of households. However, there were losses in the sample because some people have chosen not to participate and others were not in their homes at the time of data collection, so 386 users participated in the study, with 224 from team 1 and 162 from team 2.

We used as data collection instrument a questionnaire with closed questions during an interview conducted by researchers. The variables were: profile of respondents; practice of physical activity; if they practice it, which kind they perform; the frequency; the duration and location; and if they do not perform it, why not. Data collection was held from October to February 2011, at the users' homes, according to their availability.

The data were gathered through Microsoft Excel 2007 program, with absolute and relative distribution of the data obtained by questionnaires.

The development of the study followed the guidelines established by Resolution No. 196/96 of the National Health Council, which regulates the standards applied to research directly or indirectly involving humans.

Preceding fieldwork, the research project was submitted to the Research Ethics Committee of the State University of Paraíba, which issued a favorable opinion, with the Certificate of Presentation to Ethics Assessment (CAAE) number 4114.0.000.133-10. The collection took place in the homes of registered users after they were informed of the study purpose and signed the Free Informed Consent.

RESULTS AND DISCUSSION

Participants were 386 users, of which 319 (82.6%) were female and only 67 (17.1%) were male. The data shows a large number of women participating in the research, however, this can be explained by the time of collection of research data - morning and afternoon - most of the time when men were working and women remained at home to perform household chores.

As for education, it was observed that 155 (40.2%) had not finished elementary school, 90 (23.3%) completed high school, 57 (14.8%) completed elementary school, 42 (10.9%) has incomplete high school, 27 (7.0%) higher education and 15 (3.8%) were illiterate.

When users of BFHU of Malvinas I were asked about the practice of physical exercise, 275 (71.24%) said they did not practice and 111 (28.76%) answered they practiced it. This figure is worrying, since the care, essential to human survival, is increasingly being attributed to health professionals and services, exempting the subject of self-care¹⁷. The low compliance of users to physical activity was also reported in another study that showed percentage of compliance of 26%¹⁸.

When crossing the data of educational level and practice of physical activity among all 386 participants and observing the adherence in each stratum, it was found that among the illiterate individuals there was no adherence to physical activity; among the 155 who had incomplete elementary education only 35 (22.5%) adhered to it; of the 57 who have completed elementary education only 12 (21%) adhered to it; of the 42 who did not finish high school, 32 (76%) informed adherence to physical activity; among the 90 who completed high school, only 11 (12%) performed physical activity and 21 (78%) of the 27 who attended the higher education said they performed physical activity.

In the study sample, the stratum of education with the highest adherence was higher education, followed by incomplete high school. The relationship between socioeconomic and educational status are evidenced in several studies, and it is highlighted that people with better financial conditions and level of education have easier access to health services and consequently to information and health care⁷. Another reason is that people with a higher educational background have more free time to perform physical activity, since individuals without such training are involved in domestic activities, especially women^19.

The improvement of these statistics on behalf of physical activity can be achieved by the health professional advice through incentive campaigns, and by the development of physical activity groups formed by users of health facilities. The campaigns can act as the most influential means of information, as they could answer questions of people and they could also inform the benefits of exercising for health in a more clear, i.e., more accessible manner. On the other side, the groups can serve as a means for exchanging experiences between participants²⁰.

The decrease in physical exercise is observed around the world, despite its importance for the promotion and prevention of both physical and mental health. In Brazil, although the number of studies to find the level of physical activity in the population is small, the research carried out so far show us a tendency to leisure physical inactivity^19,21.

As to the reasons of not practicing physical activity, 105 (38.2%) answered that it was the lack of time that prevented them, 22 (8%) did not practice it due to complications of disease, 21 (7.63%) due to pain and tiredness and 127 (46.17%) said other reasons, mentioning their very indolence.

The various reasons that participants presented as a justification for not performing physical activity reveals that the quality of life proportioned by exercising, widely publicized by the media, is being left out, especially due to lack of time, as revealed in the research. In addition, this result shows that the improvement of quality of life through the practice of physical activity has not yet acquired the necessary importance among participants.

Among the people who performed physical activities, walking showed up with 101 (91%), and only 10 (9%) mentioned other activities. This percentage shows that even without proper environment, such as local streets with bad pavement, with intensive automobile movement and no specific material, some participants are moving to improve their quality of life²².

As for the frequency of physical exercises, 62 (55.88%) reported performing it more than three times a week, 31 (27.92%) three times a week, 10 (9%) twice a week and 8 (7.2 %) only once a week. Among the practitioners, most are aware that physical activity must be exercised more frequently, with recommendation of at least three intercalary days a week, and ideally every day.

In this sense, the team should seek, through dialogue and health education, agreeing with the users modes of caring for health, sharing the responsibility with care ^23-25.

Regarding the time taken for completion of the exercise, 80 (72.03%) of respondents answered from 30 to 60 minutes, 11 (9.90%) more than 60 minutes, 11 (9.90%) from 20 to 30 minutes and 9 (8.10%) less than 20 minutes.

The time made available by respondents to the practice of physical activity, from 30 to 60 minutes daily, reveals that those who already practice it are able to remain longer in constant activity, perhaps because they realize its many benefits, and follow the recommendations for the health promotion and maintenance in adults and elderly, which advise performing at least 30 minutes of aerobic physical activities of low to moderate intensity, from 3 to 5 times a week²⁶.

CONCLUSION

The study achieved its objective as it defined the profile of users of the health unit analyzed, individualising this reality. This shows that, for each health unit, professionals, in encouraging physical activity, must do it guided by the needs and characteristics of the population served, so that the implementation of a program of this nature is a viable initiative both from the social and from health promotion point of view

Compared to those who do not exercise, most replied that does not do it due to lack of time, which is a significant concern because often the importance of this practice is not taken into account and therefore people do not reserve an appropriate time period for the realization of it. Thus, it is required to raise awareness of the importance of physical activity and its benefits, such as reducing harm to health and a better quality of life.

Regular physical activity has been emerging as an important resource to be included into Primary Care in its health promotion activities, as it brings a variety of benefits for the population, such as preventing diseases and non-communicable diseases. Therefore, we consider the need to include physical activity, in addition to general health measures to promote the health of the population, to reduce the risk of developing disease and to improve the quality of life.

The study had some limitations and the main of them was the fact that the implementation of the interview was applied to a small number of male users due to the fact that they were not in their homes during the shifts of data collection, and thus the research tended to consider the results only for the female population. This also prevented the crossing of data relating physical activity to the gender issue.

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