ABC | Volume 113, Nº4, October 2019

Updated Updated Cardiovascular Prevention Guideline of the Brazilian Society Of Cardiology – 2019 Arq Bras Cardiol. 2019; 113(4):787-891 12.7. Population Aspects of Physical Activity Physical activity includes all forms of human movement and active life, including walking, exercise, as well as sports, and is a natural behavior that confers many benefits. 648,649 The urgency of addressing NCD, including CVD, which contribute to a significant burden of premature death, disease, disability, and economic burden for all countries is emphasized. 648,649 To reaffirm that physical inactivity is a major factor in modifiable risks to NCD. As an important point of the strategy to reduce the burden of NCD, as articulated in the WHO Global Action Plan for NCD prevention and control, 2013-2020. 627,648,649 Recognizing this strong link between physical activity and major noncommunicable diseases, WHO member states agreed on a relative 10% reduction in the prevalence of physical inactivity by 2025 as one of nine global targets for improving the prevention and treatment of noncommunicable diseases. In Brazil, according to VIGITEL 2017, physical activities practiced in four domains (leisure, occupational activity, commuting and domestic activities), which allow building multiple indicators of physical activity standard. 650 In addition, the frequency of adults who, in their free time spend: a) three or more hours of the day watching television; b) three or more hours of the day using computer, mobile or tablet; and c) three or more hours of the day watching television or using a computer, mobile phone or tablet. The frequency of adults practicing leisure time physical activity equivalent to at least 150 minutes of moderate physical activity per week ranged from 29.9% in São Paulo to 49.6% in the Federal District. Among men, the highest frequencies were found in Macapá (57.1%), São Luís (54.1%) and Distrito Federal (53.8%) and the lowest in São Paulo (36.0%), João Pessoa. (39.5%) and Fortaleza (42.1%). Among women, the highest frequencies were observed in the Federal District (45.9%), Palmas (41.9%) and Curitiba (37.7%). The smallest were in São Paulo (24.8%), Porto Alegre (26.7%) and Recife (28.1%), 650 showing a high prevalence of sedentary individuals. Physical activity in leisure time is increasing. In 2009, the indicator was 30.3%, and in 2016, 37.6%. Prevalence decreases with age, being more common among young people from 18 to 24 years old. 650 The situation is not different from other countries, whether developed or developing. Prevalence in 2016 was more than twice as high in high-income countries (36.8%, 35.0–38.3%) than in low-income countries (16.2%, 14.9–9.9) and physical inactivity increased in high-income countries over time (31.6%, 27.1–37.2 in 2001). If current trends continue, the global physical activity target for 2025 (a relative 10% reduction in physical inactivity) will not be met. Policies to increase population levels of physical activity need to be prioritized and expanded urgently. 649 Physical inactivity is one of the top 10 risk factors for global mortality, causing about 3.2 million deaths each year. 651,652 Sedentary adults have a 20-30% increase in risk of all mortality causes compared with those who do at least 150 minutes of moderate physical activity per week, or equivalent, as recommended by WHO. Regular physical activity reduces the risk of ischemic heart disease, stroke, diabetes, and breast and colon cancer. In addition, regular physical activity is a major determinant of energy expenditure and is therefore critical to energy balance, weight control and obesity prevention. 651,652 12.8. Population Approach to Increased Physical Activity The proposed policy options aim to promote the implementation of the global strategy regarding diet, physical activity and health and other relevant strategies, and to promote the additional benefits of increasing physical activity levels in population, such as improved educational performance and social and mental health benefits , coupled with cleaner air, reduced traffic, less congestion and links to healthy child development and sustainable development. 654,655 In addition, interventions to increase participation in physical activity throughout the population for which favorable cost-effectiveness data are emerging and should be promoted. The objective is to contribute to achieving the voluntary global goals listed below: 654,655 A relative 10% reduction in the prevalence of physical inactivity. • It can stop the rise of diabetes and obesity. • Lead to a 25% relative reduction in the prevalence of hypertension or contain the prevalence of increased BP according to national realities. Proposed policy options include: • Adopt and implement national guidelines on physical activity for health. • Consider establishing a multisectoral committee or similar body to provide strategic leadership and coordination. • Develop appropriate partnerships and involve all segments of society concerned, levels of government, non- governmental organizations (NGO), civil society, scientific societies and economic operators, in the active and appropriate implementation of actions aimed at increasing physical activity at all ages. • Develop policy measures in cooperation with relevant sectors to promote physical activity through activities of daily living, including through “active transport”, recreation, leisure and sport, for example: National, state and municipal urban planning and transport policies to improve accessibility, acceptability and safety of support infrastructure for walking and cycling. • Improvement in the provision of quality physical education in educational settings (for elementary and high school students) including opportunities for physical activity before, during and after the formal school day. Actions to support and encourage “physical activity for all” initiatives. • Creation and preservation of natural environments that facilitate physical activity in schools, universities, workplaces, clinics and hospitals, and in the wider community, with a particular focus on providing infrastructure to support active transportation such as walking and cycling, recreation and active play and participation in all types of sports. 864