[Level of physical activity in the prevention of excess visceral fat in postmenopausal women: how much is needed?]

Combined Effect of Leisure-Time Physical Activity and Sedentary Behavior on Abdominal Obesity in ELSA-Brasil Participants

INTRODUCTION

Abdominal obesity is a pattern of obesity that has been considered a public health problem. Physical activity is considered an important factor for the prevention of abdominal obesity. Increased time in sedentary behavior has been associated with negative health outcomes, including abdominal obesity.

OBJECTIVE

The aim of this study was to investigate which combination of leisure-time physical activity and sedentary behavior contributes most to the prevention of abdominal obesity in adults participating in ELSA-Brasil (Longitudinal Study of Adult Health).

METHODS

The study was cross-sectional and participants from the first follow-up of the ELSA-Brasil cohort (2012-2014) were analyzed. The independent variables were physical activity, assessed by IPAQ, and sedentary behavior, assessed by a standard questionnaire applied in ELSA-Brasil; the dependent variable was abdominal obesity, determined by waist circumference. The covariates analyzed were the following: age, education, binge drinking, smoking and menopause. The associations between the dependent variable and the independent variables were analyzed using logistic regression. The odds ratio with 95 CI% was estimated.

RESULTS

For men, the combinations were more significant when they were more physically active and spent less time on the sedentary behaviors analyzed, on both a weekday and a weekend day. For menopausal women, both younger and older, all associations of the combinations between sufficient leisure-time physical activity and little time spent in sedentary behaviors contributed to the prevention of abdominal obesity. In non-menopausal women, positive associations were observed in almost all combinations between leisure-time physical activity and sedentary behaviors, with some results that were not statistically significant among younger women.

CONCLUSIONS

Our results showed that being sufficiently active and reducing the time spent in sedentary behavior was the combination that contributed the most to the prevention of abdominal obesity, both in men and women.

Amount of physical activity necessary for a normal level of high-sensitivity C-reactive protein in ELSA-Brasil: a cross-sectional study

BACKGROUND

Studies have shown that physical activity levels can be inversely associated with high-sensitivity C-reactive protein (hs-CRP) levels. However, the amount of physical activity required to maintain normal hs-CRP levels is still a matter for speculation.

OBJECTIVE

To identify the amount of physical activity necessary to discriminate the hs-CRP levels in adults.

DESIGN AND SETTING

Cross-sectional study at six teaching and research institutions.

METHODS

The study sample comprised 10,231 adults aged 35 to 74 years who were participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Receiver operating characteristic (ROC) curves were constructed to compare the amount of physical activity in two domains (leisure time and commuting) with hs-CRP levels. The sensitivity and specificity were calculated to identify the best cutoff for physical activity level that would be needed to maintain normal levels of hs-CRP (< 3 mg/l).

RESULTS

The area under the ROC curve was only statistically significant for discriminating normal levels of hs-CRP according to the amount of physical activity when the two study domains were added together. The accumulated physical activity level of 200 minutes/week was the best cutoff for discriminating normal levels of hs-CRP in adults of both sex.

CONCLUSIONS

Physical activity in the leisure-time and commuting domains together, of duration 200 minutes/week, was associated with normal hs-CRP values.

Adherence to physical activity in adults with chronic diseases: ELSA-Brasil

OBJECTIVE

The objective of this study is to investigate the adherence and the factors that influence adherence to physical activity in adults with dyslipidemia, hypertension, or diabetes.

METHODS

The analyses were based on data collected at the baseline of the 14,521 participants from the study ELSA-Brasil aged between 35 and 74 years. The level of leisure time physical activity was determined using the International Physical Activity Questionnaire. Logistic regression analyses were performed to examine the influence of the demographic data, socioeconomic conditions, perceived health status, and access to exercise facilities in the neighborhood on adherence to physical activity.

RESULTS

Men with hypertension and dyslipidemia were more active than women. The results show that 17.8%, 15.1%, and 13.9% of the subjects who reported dyslipidemia, hypertension, and diabetes, respectively, adhere to the physical activity recommendations. The factors positively associated with adherence were higher education and income. Older individuals who reported poor perceived health, were overweight and obese, regularly smoked, and had fewer opportunities to exercise in the neighborhood presented lower adherence.

CONCLUSIONS

The number of adults with dyslipidemia, hypertension, and diabetes who adhere to the physical activity recommendations is very low. Higher education and income are positively associated with adherence, while age, excess body weight, negative perceived health, regular smoking, and lack of opportunity to exercise in the neighborhood were considered barriers to physical activity.

Physical activity in Brazil: lessons from ELSA-Brasil. Narrative review

CONTEXT AND OBJECTIVE:

The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) was conducted among civil servants at six higher education institutions located in six Brazilian state capitals. The objective of this review was to identify the publications produced within the scope of ELSA-Brasil that analyzed the participants' physical activity.

DESIGN AND SETTING:

Review study using baseline data from ELSA-Brasil.

METHODS:

Narrative review of Brazilian studies on physical activity produced using data from ELSA-Brasil participants.

RESULTS:

The prevalence of leisure-time physical activity (LTPA) among ELSA-Brasil participants was low (44.1% among men and 33.8% among women). The main factors associated were social (higher schooling and family income), environmental (living in places with conditions and opportunities for physical activity) and individual (not being obese, being retired, not smoking and positive perception of body image). The perception of facilities for walking in the neighborhood was positively associated with both LTPA and commuting-related physical activity. An active lifestyle was a protective factor against several cardiometa-bolic variables (hypertension, diabetes, lipid abnormalities and cardiovascular risk over the next 10 years). Comparison between LTPA and commuting-related physical activity showed that only LTPA had a protective effect against arterial hypertension.

CONCLUSIONS:

The prevalence of physical activity among ELSA-Brasil participants was low. The main determinants were social, environmental and personal. LTPA had a greater protective efect on cardio-metabolic outcomes than did commuting-related physical activity.

Association of Habitual Patterns and Types of Physical Activity and Inactivity with MRI-Determined Total Volumes of Visceral and Subcutaneous Abdominal Adipose Tissue in a General White Population

Population-based evidence for the role of habitual physical activity (PA) in the accumulation of visceral (VAT) and subcutaneous (SAAT) abdominal adipose tissue is limited. We investigated if usual patterns and types of self-reported PA and inactivity were associated with VAT and SAAT in a general white population. Total volumes of VAT and SAAT were quantified by magnetic resonance imaging in 583 men and women (61 ± 11.9 y; BMI 27.2 ± 4.4 kg/m2). Past-year PA and inactivity were self-reported by questionnaire. Exploratory activity patterns (APAT) were derived by principal components analysis. Cross-sectional associations between individual activities, total PA in terms of metabolic equivalents (PA MET), or overall APAT and either VAT or SAAT were analyzed by multivariable-adjusted robust or generalized linear regression models. Whereas vigorous-intensity PA (VPA) was negatively associated with both VAT and SAAT, associations between total PA MET, moderate-intensity PA (MPA), or inactivity and VAT and/or SAAT depended on sex. There was also evidence of a threshold effect in some of these relationships. Total PA MET was more strongly associated with VAT in men (B = -3.3 ± 1.4; P = 0.02) than women (B = -2.1 ± 1.1; P = 0.07), but was more strongly associated with SAAT in women (B = -5.7 ± 2.5; P = 0.05) than men (B = -1.7 ± 1.6; P = 0.3). Men (-1.52 dm3 or -1.89 dm3) and women (-1.15 dm3 or -2.61 dm3) in the highest (>6.8 h/wk VPA) or second (4.0-6.8 h/wk VPA) tertile of an APAT rich in VPA, had lower VAT and SAAT, respectively, than those in the lowest (<4.0 h/wk VPA) tertile (P ≤ 0.016; P trend ≤ 0.0005). They also had lower VAT and SAAT than those with APAT rich in MPA and/or inactivity only. In conclusion, our results suggest that in white populations, habitual APAT rich in MPA might be insufficient to impact on accumulation of VAT or SAAT. APAT including ≥ 4.0-6.8 h/wk VPA, by contrast, are more strongly associated with lower VAT and SAAT.

Associação entre o nível de atividade física e a área de gordura visceral em mulheres pós-menopáusicas

INTRODUÇÃO: O aumento da gordura visceral abdominal está associado à redução dos níveis de atividade física habitual e gera na mulher pós-menopáusica, o surgimento da doença da inatividade física, caracterizada pela manifestação de um conjunto de patologias, entre as quais se incluem diabetes mellitus do tipo 2 e doenças cardiovasculares. Por outro lado, a atividade física regular parece ter impacto significativo na prevenção tanto da gordura intra-abdominal quanto das complicações metabólicas e cardiovasculares.OBJETIVO: Verificar a associação entre a caminhada e a atividade física de moderada intensidade com a área de gordura intra-abdominal em mulheres pós-menopáusicas.MÉTODOS: A amostra foi composta por 239 mulheres com média de idade de 57,4 ± 6,6 anos participantes do programa "Menopausa em Forma". Para análise da atividade física foi utilizado o IPAQ versão longa. Consideraram-se os valores de 1.601 kcal/semana na caminhada e 2.283 kcal/semana na atividade física de moderada intensidade como suficientes para prevenção do excesso de gordura intra-abdominal. Utilizou-se a análise de regressão logística para estimar a odds ratio (OR), com intervalo de confiança de 95%.RESULTADOS: Após análise multivariada observou-se que a caminhada ofereceu proteção contra o excesso de gordura intra-abdominal, principalmente nas mulheres com períodos menstruais regulares, OR = 0,22 (0,08-0,62) e que não fazem reposição hormonal, OR = 0,05 (0,01-0,49). Já o nível de atividade física de intensidade moderada ofereceu proteção contra a gordura intra-abdominal independentemente da reposição hormonal ou dos períodos menstruais regulares, OR = 0,37 (0,14-0,66).CONCLUSÃO: A caminhada e principalmente o nível de atividade física de moderada intensidade podem ser importantes para prevenção do excesso de gordura intra-abdominal e suas complicações metabólicas e cardiovasculares em mulheres pós-menopaúsicas.