Victor Matsudo

LightingLighting thethe Fire Fire

The Brazil ExperienceThe Brazil Experience

Barbados

March 6th, 2009

Active Caribbean Workshop 2009

Road to the Wellness Revolution matsudo@celafiscs.org.br

“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