IJCS | Volume 32, Nº5, September/October 2019

478 Table 3 - Multivariate analysis OR 95% confidence interval Predicted %VO 2 1.02 (0.979 - 1.046) Occupation n (%) Non-physicians 1.00 Cardiologist physicians 2.01 (1.243 - 3.267) Non-cardiologist physicians 1.82 (1.009 - 3.300) PA-I Classification n (%) Inactive 1.00 Lightly active 1.62 (0.76 - 3.014) Moderately active 1.93 (1.105 - 3.39) Highly active 2.25 (1.238 - 4.089) Meira et al. Talk the talk and walk the walk! Int J Cardiovasc Sci. 2019;32(5):473-480 Original Article compared with the general population. 14,15 In contrast, Borgan et al.,16 detected unfavorable lifestyle habits (70% were physically inactive and 33% obese) among physicians in Bahrai. Aasland et al., 17 reported higher mortality in physicians than other higher education professionals in Norway. The association between the adoption of healthy lifestyle habits by physicians and the quality of their advice on prevention strategies is very well established. Bleich et al., 18 showed that non-obese physicians are more likely to record an obesity diagnosis in the medical chart, and to initiate weight loss counseling to their patients as compared with obese physicians. Pipe et al., 19 interviewed 4,473 doctors and found that smoking physicians were less likely to initiate smoking cessation interventions than non-smoking physicians. Abramsonet al., 20 evaluated 298 doctors of several specialties and found that those who practiced aerobic exercise had 5.72 (95% CI 2.41-13.54) greater chance to recommend aerobic exercise, and those who practiced resistance exercise were 4.55 times more likely to counsel their patients on the benefits of these exercise (95%CI 2.61-7.91) than those who did not exercise. A regular practice of exercise can be difficult to be maintained in the beginning of the medical course, which coincides with the end of adolescence or initial of adult life. During more than ten years of medical school, including both undergraduate and residency programs, the lack of time and mainly the lack of encouragement to be physically active, contribute to a sedentary lifestyle and other unhealthy habits among doctors. This leads to underestimation of the practice of physical exercise as a strategy of disease prevention and health promotion for doctors and their patients. Dacey et al., 21 in a detailed systematic review on physical activity counseling education in medical schools highlighted that the first step to promote more effective physician practices on physical activity counseling is to address students’ physical activity behavior. To our knowledge, few medical schools include the discipline of physical education in their programs, and when included, it is not given due attention and importance, reflecting bad quality university sports programs in terms of organization and structure, and inadequate for education, leisure and health promotion required by young students. As a result, medical professionals are less healthy and less likely to address physical inactivity of their patients as a health problem. Besides, this academic program model ultimately has a negative impact on society, as it promotes a poor interaction between physicians and physical educators, who in turn have a very important role in the fight against a sedentary lifestyle. Physical inactivity is an important public health problem in the world that has been target of many strategies supported by government funds 22-24 and foundations. 25-26 Physicians play a key and, so far, irreplaceable role in this lifestyle changing process, and in this context, a medical visit turns to be an excellent opportunity to achieve that. In Brazil, 54.7% of the population, mostly women and older subjects, reported having been to a medical appointment in the last 12 months, and 71.2% of the population seek healthcare services regularly. Kreuter et al., 27 showed that patients who received physician advice on health promotion before receiving printed materials on the same theme were 35% to 55% more likely to quit smoking, change dietary habits, or begin to exercise. The present study, corroborating previous studies, show that physicians with healthy lifestyle habits have greater ability and/or knowledge to motivate patients to adopt healthy habits. 28 A cross sectional study conducted during a medical congress aiming to evaluate knowledge of participants is subject to selection bias, since it is expected that the level of knowledge of these participants, involved in continued education, is greater than of professionals