Victor Matsudo Lighting the Fire The Brazil Experience Barbados March 6th, 2009 Active Caribbean Workshop 2009 Road to the Wellness Revolution

“The Samba – Caribbean Connection”.

It is not a Matter of What ; But a Matter of How ! Time for Action; and for Revolution !

CELAFISCS * * * * * * * * * * Center of Studies of the Physical Fitness Research Laboratory - São Caetano do Sul Center of Studies of the Physical Fitness Research Laboratory - São Caetano do Sul

Victor Matsudo Scientific Director Douglas R Andrade Past-Vice-President Sandra Matsudo General Director Erinaldo L de Andrade Secretary General Timóteo L Araújo President Gláucia F Braggion 2nd Secretary Luis C de Oliveira Vice-President CELAFISCS - Executive Board

CELAFISCS Family !

We have a dream

- Agita São Paulo - Agita São Paulo CELAFISCSCELAFISCS Physical Activity Caloric Intake 3000 Kcal d Kcal d Kcal d Kcal d -1 Subsistence Efficiency 3:1 Subsistence Efficiency 3:1 Subsistence Efficiency 7:1 Subsistence Efficiency 7:1 Pre-Industrial Contemporary International Association for the Study of Obesity, 2003

Prevalence of Risk Factors in São Paulo Rego et al. Braz J Pub Health,1990 Rego et al. Braz J Pub Health,1990 %

Monteiro & Matsudo, Pan American Journal Public Health, 14(4): ,2003 Any Leisure-Time Physical Acitvity According to Socio-Economic Level

Education n: – H: 5234 / M: 5799 – > 20 anos – Home-Interview Monteiro 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 2 Million Deaths Number of deaths (000s) Sedentarism WHO, 2005

WORLD DISTRIBUTION OF CHRONIC DISEASES & NATIONAL INCOME WORLD DISTRIBUTION OF CHRONIC DISEASES & NATIONAL INCOME Low Income Countries 35% Average Income Countries 37% High Income Countries 20% Average/High Income 8% WHO, 2005

The Science The Science

Do Scientific Evidences Change Behavior ? Do Scientific Evidences Change Behavior ?

Morris et al Angina Incidence ( ) Cardio-vascular deathes Total

HIP FRACTURE IN MEN BY CHANGE IN PHYSICAL ACTIVITY BETWEEN 50 AND 60 YEARS OF AGE HIP FRACTURE IN MEN BY CHANGE IN PHYSICAL ACTIVITY BETWEEN 50 AND 60 YEARS OF AGE MICHAELSSON, K. et al.PLoS. Med. 4 (6):1094:1100,2007 Cumulative Percentage with Hip Fracture (%) Hip Fracture (%) Age in Years 35 YEARS OF FOLLOW-UP HOMENS Born Between 1920 and 1924 Cohort Uppsala Longitudinal Study of Adult Men (ULSAM) 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

1 Ref. 1,65 (1,13-2,41) 2,65 (1,55-4,24) PHYSICAL ACTIVITY AND HIP FRACTURE IN MEN 35 YEARS OF FOLLOW-UP MICHAELSSON, K. et al.PLoS. Med. 4 (6):1094:1100, HOMENS Born Between 1920 and 1924 Cohort Uppsala Longitudinal Study of Adult Men (ULSAM)

P for Trend = Harzad Ratios Associations Between Breast Cancer Outcomes and Physical Activity 2 Years After Diagnosis P for Trend = Irwin et al, J Clin Oncol 26: , women x Age= % 70% 64% 67%

(0.46 – 0.98) (0.49 – 0.95) (0.47 – 0.89)(0.44 – 0.87) Ref. Relative Risk Physical Activity (Times / Week LEITZMANN MF et al.Am. J. Preventive Medicine 2009; 36(2) : Relative Risk of Gastric and Esophagic Carcinoma According to Physical Actitivty Cohort Homens e Mulheres 50 a 71 Anos de Idade 8 Anos de Seguimento 523 Casos de Carcinoma Esofágico 642 Casos de Carcinoma Gástrico NIH – AARP Diet and Health Study - 38% p for trend 0,024 Noncardia Gastric Adenocarcinoma

Total: years: years: 3224 last yr: 645 Humans: years : years: 2814 last yr: 511 Bergamaschi, J. May 30th, 2007 Publications on P.A.& CVD

Matsudo, V Sea Pines Course, Physical Activity Published Papers Physical Activity Academic Paradox

Worst than a Tragedy is Not to Learn with the Tragedy ! Free Thinking…

Medical Perspective (Disease) Drugs Surgery

Pharmacological Determinism Surgery Determinism

Building Health !

WILLIAMS, P.T. Med.Sci.Sports Exerc. 40(3): ,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 < Walking distance(km) < >2.1 Walking speed (m/s)

EXER STENT “STENT” or PHYSICAL ACTIVITY SURVIVAL EXERCISE

Building Health through Physical Activity ! Physical Activity !

Mental Health Diet Physical Activity

Building Health through Healthy Behaviors

Physical Activity Diet Mental Health (No Tabaco/ Alchool)

Building Health Surgery Drugs

The Vision Putting Theory and Practice in one Sentence !

Knowledge Management Knowledge Management

PIRACICABA ILHA BELA ASSIS SÃO SEBASTIÃO AMPARO S.C.S PRESIDENTE PRUDENTE LIMEIRA SOROCABA SANTOS MARÍLIA S.B.C. DIADEMA SANTANA DO PARNAÍBA JACAREÍ S.J.C. CAPITAL BARRETOS RIBEIRÃO PRETO BAURU CÂNDIDO MOTA PIRAPOZINHO EMILIANOPÓLIS OURINHOS Sta. Cruz da Conceição Elias Fausto IPEÚNA SÃO PAULO STATE Population: 40 million km2 Area: km2 Cities: 645 Some Partners of Agita São Paulo

Supportive Behaviors Supportive Behaviors SOCIAL ENVIRONMENTINTRAPERSONAL `Constructed Environment `Constructed Environment TransportTransport Architectural Architectural UrbanSuburbanUrbanSuburban Biological Policies Governing Resources Policies Governing Resources Policies Governing Incentives Policies Governing Incentives Demographic “MOBILE MANAGEMENT” - ECOLOGICAL MODEL PHYSICAL ENVIRONMENT Natural Environment Natural Environment Cognitive/ Affective Cognitive/ Affective Cultural Social Climate InformationInformationGeographyGeography WeatherWeather EntertainmentEntertainment RecreationRecreation Matsudo V et al, Perspectives 2004 Behavioural

Supportive Behaviors Supportive Behaviors SOCIAL ENVIRONMENT INTRAPERSONAL `Constructed Environment `Constructed Environment TransportTransport Architectural Architectural UrbanSuburbanUrbanSuburban Biological Policies Governing Resources Policies Governing Resources Policies Governing Incentives Policies Governing Incentives Demographic “MOBILE MANAGEMENT” - ECOLOGICAL MODEL PHYSICAL ENVIRONMENT Natural Environment Natural Environment Cognitive/ Affective Cognitive/ Affective Cultural Social Climate InformationInformationGeographyGeography WeatherWeather EntertainmentEntertainment RecreationRecreation Matsudo V et al, Perspectives 2004 Behavioural

Traditional Partners Health, Sports & Educational Sector Non-Traditional Partners New Players (Marketing, Communication, Transport, Urban Planning, Environment, Economy, Management...) Promoting PA in a World of Diversity

Partnership Executive Board Meeting

GovernmentGovernment NGOs & Private Sector NGOs & Private Sector AGITA BRASIL Agita São Paulo THE TWO-HATS APPROACH

AMAPÁ

Clear Message ! Clear Message !

Moderate PA Works ! Moderate PA Works !

RISK OF DEATH X TOTAL ENERGY EXPENDITURE Kj.wk -1 RR 20% Kj.wk -1 RR  % % < referência < (0.72 – 0.88) < (0.65 – 0.83) < (0.69 – 0.93) - 20  (0.64 – 0.84) - 27  LEE et al., Am J Epidemiol, 2000 p < 0,001 27% 74% 26% 96% Observational Cohort Study Men ; Deathes