1. Matsudo, Public Health Nutrition, Feb 2002 AGITA SÃO PAULO PROGRAM Scientific Evidences Other Countries Experiences Other Countries Experiences Epidemiological Former Brazilian Experiences Former Brazilian Experiences

2. Matsudo, Public Health Nutrition, Feb 2002 University of Jyväskylä 5th Annual Congress of the European College of Sports Sciences 5th Annual Congress of the European College of Sports Sciences Lessons of the Past for Guidance in the Future: Matching the Needs and Possibilities Lessons of the Past for Guidance in the Future: Matching the Needs and Possibilities Agita São Paulo Program Victor Matsudo Agita São Paulo Program Victor Matsudo

3. Matsudo, Public Health Nutrition, Feb 2002 AGITA SÃO PAULO PROGRAM Medical Committee Medical Association Medical TV Health Professionals Medical Students Publishing in Scientific Journals OrthopedistsProfile Other Area Congresses

4. Matsudo, Public Health Nutrition, Feb 2002 Participation in Recommended Physical Activity Excluding Walking Excluding Walking OverallOverall MenMen WomenWomen AGITA SÃO PAULO PROGRAM GenderPercent95% CI 39.739.7 32.132.1 47.447.4 35.6 - 43.9 26.5 - 37.6 41.4 - 53.4

5. Matsudo, Public Health Nutrition, Feb 2002 Participation in Recommended Physical Activity Including Walking Including Walking OverallOverall MaleMale FemaleFemale GenderPercent95% CI 54.854.8 48.748.7 61.061.0 50.6 - 59.0 42.8 - 54.6 55.1 - 66.8 AGITA SÃO PAULO PROGRAM

6. Matsudo, Public Health Nutrition, Feb 2002 Participation in Recommended Physical Activity OverallOverall 18 - 29 30 - 49 AgePercent95% CI 39.739.7 54.354.3 36.036.0 35.6 - 43.9 45.7 - 63.0 30.0 - 42.0 Excluding Walking Excluding Walking > 50 33.533.5 26.3 - 40.8 AGITA SÃO PAULO PROGRAM

7. Matsudo, Public Health Nutrition, Feb 2002 Participation in Recommended Physical Activity OverallOverall 18 - 29 30 - 49 AgePercent95% CI 54.854.8 63.563.5 47.247.2 50.6 - 59.0 55.2 - 71.9 41.0 - 53.4 > 50 59.659.6 52.1 - 67.1 AGITA SÃO PAULO PROGRAM Including Walking Including Walking

8. Matsudo, Public Health Nutrition, Feb 2002 Participation in Recommended Physical Activity Excluding Walking Excluding Walking AGITA SÃO PAULO PROGRAM OverallOverall NoNo YesYes Know Principal Objective? Percent 95% CI 38.138.1 35.335.3 43.043.0 32.5 - 43.7 28.4 - 42.2 33.5 - 52.5

9. Matsudo, Public Health Nutrition, Feb 2002 Participation in Recommended Physical Activity Excluding Walking Excluding Walking AGITA SÃO PAULO PROGRAM OverallOverall NoNo YesYes Know Principal Objective? Percent 95% CI 31.831.8 33.133.1 29.629.6 26.4 - 37.3 26.2 - 39.9 20.7 - 38.5 Inactive Inactive

10. Matsudo, Public Health Nutrition, Feb 2002 Participation in Recommended Physical Activity AGITA SÃO PAULO PROGRAM Including Walking Including Walking OverallOverall NoNo YesYes Know Principal Objective? Percent 95% CI 55.955.9 53.953.9 59.559.5 50.2 - 61.7 46.7 - 61.1 50.1 - 68.9

11. Matsudo, Public Health Nutrition, Feb 2002 Participation in Recommended Physical Activity Including Walking Including Walking AGITA SÃO PAULO PROGRAM OverallOverall NoNo YesYes Know Principal Objective? Percent 95% CI 10.910.9 13.113.1 7.17.1 7.2 - 14.5 8.1 - 18.0 2.0 - 12.1 Inactive Inactive

12. Matsudo, Public Health Nutrition, Feb 2002 Workers Students Elderly Targeting Groups AGITA SÃO PAULO PROGRAM

13. Matsudo, Public Health Nutrition, Feb 2002 AGITA SÃO PAULO PROGRAM Surveillance Physical Activity Attitudes Physical Activity Level Program Knowledge Behavior Stages Knowledge Barriers

14. Matsudo, Public Health Nutrition, Feb 2002 Sciences Mysthics Ethics Partners Success AGITA SÃO PAULO PROGRAM PAHO ADVISER REPORT, 2000

15. Matsudo, Public Health Nutrition, Feb 2002 Banners Hand-fan Car tape Folders Bus-door Mouse pad Umbrella T-Shirts Posters Stickers Marketing Materials AGITA SÃO PAULO PROGRAM

16. Matsudo, Public Health Nutrition, Feb 2002 Outdoor Pens Slides Presentation Slides Presentation Wrap Pyramids Pins Key-holder Plastic Bags Plastic Bags Ballons Videos Bookmark Bottons Draft Papers Block Draft Papers Block Refrigerator Magnetic Refrigerator Magnetic Marketing Materials Marketing Materials

17. Matsudo, Public Health Nutrition, Feb 2002 AGITA SÃO PAULO PROGRAM Intellectual Partnership National National International International Scientific Board Scientific Board

18. Matsudo, Public Health Nutrition, Feb 2002 Governmental Governmental Non-Governmental Non-Governmental Executive Board (Monthly Meeting) Executive Board (Monthly Meeting) AGITA SÃO PAULO PROGRAM Institution Partnership

19. Matsudo, Public Health Nutrition, Feb 2002 AGITA SÃO PAULO PROGRAM Inclusion Principle Intellectual Intellectual Institutional Institutional Using the Existing Structured Programs and Groups Using the Existing Structured Programs and Groups One-step-ahead Model One-step-ahead Model Message: Message: - Moderate - Cumulative - Cumulative

20. Matsudo, Public Health Nutrition, Feb 2002 Brazilian Ministery of Health Brazilian Ministery of Health AGITA SÃO PAULO PROGRAM Political Aspects São Paulo State Secretary of Health São Paulo State Secretary of Health The São Paulo Manifesto The São Paulo Manifesto World Health Organization (WHO) World Health Organization (WHO) Pan-American Health Organization (PAHO) Pan-American Health Organization (PAHO) Centers for Disease Control and Prevention (CDC) Centers for Disease Control and Prevention (CDC)

21. Matsudo, Public Health Nutrition, Feb 2002  Politics  Environment  Curriculum on Health Education  Extra-Curriculum Activities  Family Involvement  Human Resources Training  Health Services  Community Programs  Evaluation  Politics  Environment  Curriculum on Health Education  Extra-Curriculum Activities  Family Involvement  Human Resources Training  Health Services  Community Programs  Evaluation RECOMMENDATIONS TO INTERVENTION PROGRAMS TO PROMOTE PHYSICAL ACTIVITY POPULATION RECOMMENDATIONS TO INTERVENTION PROGRAMS TO PROMOTE PHYSICAL ACTIVITY POPULATION

22. Matsudo, Public Health Nutrition, Feb 2002 TYPES OF ECOLOGICAL MODELS Number of behavior settings Number of behavior settings Acess to behavior settings Use of activity behavior settings The number of supervised programs Acess to, and quality of, programs Use of youth activity programs Number of behavior settings Number of behavior settings Acess to behavior settings Use of activity behavior settings The number of supervised programs Acess to, and quality of, programs Use of youth activity programs

23. Matsudo, Public Health Nutrition, Feb 2002  São Paulo  Rio de Janeiro  Porto Alegre  Belo Horizonte  Curitiba  Brasília  São Paulo  Rio de Janeiro  Porto Alegre  Belo Horizonte  Curitiba  Brasília CARDIO-VASCULAR MORTALITY RATES (Deaths/100.000) 45-64 ys CARDIO-VASCULAR MORTALITY RATES (Deaths/100.000) 45-64 ys 306.2 400.1 402.2 210.8 389.9 139.3 306.2 400.1 402.2 210.8 389.9 139.3 107.7 143.2 123.8 62.7 135.4 58.4 107.7 143.2 123.8 62.7 135.4 58.4 Men Women XIII World Congress of Cardiology, Brazil 1998

24. Matsudo, Public Health Nutrition, Feb 2002 300.000 820 34 1 300.000 820 34 1 CARDIO-VASCULAR MORTALITY IN BRAZIL Deaths per year Deaths per day Deaths per hour Deaths every 2 min Deaths per year Deaths per day Deaths per hour Deaths every 2 min XIII World Congress of Cardiology, Brazil 1998

25. Matsudo, Public Health Nutrition, Feb 2002  Florianopolis  Salvador  Recife  Belem  Natal  Campo Grande  Florianopolis  Salvador  Recife  Belem  Natal  Campo Grande CARDIO-VASCULAR MORTALITY RATES (Deaths/100.000) 45-64 ys CARDIO-VASCULAR MORTALITY RATES (Deaths/100.000) 45-64 ys 234.4 182.9 274.7 220.0 206.2 307.4 234.4 182.9 274.7 220.0 206.2 307.4 62.4 79.4 100.9 80.3 51.2 133.9 62.4 79.4 100.9 80.3 51.2 133.9 Men Women XIII World Congress of Cardiology, Brazil 1998

26. Matsudo, Public Health Nutrition, Feb 2002 NationalNational Scientific Board Agita São Paulo State Health Secretary Secretary Executive Board InternationalInternationalNon-GovernmentalNon-GovernmentalGovernmentalGovernmental Target Groups StudentsStudentsWorkersWorkersElderlyElderly CELAFISCSCELAFISCS

27. Matsudo, Public Health Nutrition, Feb 2002 AGITA SÃO PAULO PROGRAM BRAZILIAN RATES MORTALITY DEATHS /100000 STROKE CANCER HEART ATTACK YEARS DATA SUS TUBERCULOSIS

28. Matsudo, Public Health Nutrition, Feb 2002 Folders Flyers Agita Newsletter Agita Newsletter Posters Educational Materials Educational Materials Videos Manual Cable TV Conference Cable TV Conference Home-page

29. Matsudo, Public Health Nutrition, Feb 2002 Program Impact Participation in Scientific Meetings28 Participation in Scientific Meetings28 Participation in Meetings of Partners79 Participation in Meetings of Partners79 Presentation of Program 197 Presentation of Program 197 Scientific Studies20 Scientific Studies20 Publication in Newspapers86 Publication in Newspapers86 Publication in National Journals14 Publication in National Journals14 AGITA SÃO PAULO PROGRAM 18 MONTHS PERIOD

30. Matsudo, Public Health Nutrition, Feb 2002 Program Impact Publication in Journals of the Partners52 Publication in Journals of the Partners52 National Broadcasting TV35 National Broadcasting TV35 International Broadcasting TV 5 International Broadcasting TV 5 Radio Programs25 Radio Programs25 Questionnaire Applied 21.117 Questionnaire Applied 21.117 Person/Message Attained 83.749.602 Person/Message Attained 83.749.602 AGITA SÃO PAULO PROGRAM 18 MONTHS PERIOD

31. Matsudo, Public Health Nutrition, Feb 2002 Workers AgitaGalera Active Elderly Active Elderly Megaevents AGITA SÃO PAULO PROGRAM

32. Matsudo, Public Health Nutrition, Feb 2002 Everyday Home Activities Everyday Home Activities Transport Activities Transport Activities Leisure Time Activities Leisure Time Activities Settings AGITA SÃO PAULO PROGRAM

33. Matsudo, Public Health Nutrition, Feb 2002 Workshops Workshops Agita Agents Agita Agents Agita-Net Agita-Net Human Resources AGITA SÃO PAULO PROGRAM

34. Matsudo, Public Health Nutrition, Feb 2002 Inclusion Principle Inclusion Principle Partnership: Intellectual and Institutional Partnership: Intellectual and Institutional Empowering the Partnership Agenda Empowering the Partnership Agenda Similar Cause and Differences in Action Similar Cause and Differences in Action Inter and Intrasectorial Partnership Balance Inter and Intrasectorial Partnership Balance Lessons of the Past for Guidance in the Future: Matching the Needs and Possibilities Lessons of the Past for Guidance in the Future: Matching the Needs and Possibilities

35. Matsudo, Public Health Nutrition, Feb 2002 Lessons of the Past for Guidance in the Future: Matching the Needs and Possibilities Lessons of the Past for Guidance in the Future: Matching the Needs and Possibilities Non-Paid Media Approach Non-Paid Media Approach Scientific Sound Scientific Sound One Step-Ahead Model One Step-Ahead Model Clear, Simple, and Feasible Message Clear, Simple, and Feasible Message Cultural Adaptation - Pleasure Cultural Adaptation - Pleasure Surveillance Surveillance

36. Matsudo, Public Health Nutrition, Feb 2002 Learned Lessons Partnerships Partnerships Dream and Act With Potentialities Dream and Act With Potentialities Empowering the Partnership Agenda Empowering the Partnership Agenda Similar Cause and Differences in Action Similar Cause and Differences in Action Scientific Knowledge + Practical Actions Scientific Knowledge + Practical Actions Clear, Simple, and Feasible Message Clear, Simple, and Feasible Message

37. Matsudo, Public Health Nutrition, Feb 2002 Learned Lessons Improve Capacities and Potentialities Improve Capacities and Potentialities Low Level of Demanding in the Partnership Low Level of Demanding in the Partnership Personal Relationship Success Personal Relationship Success Work + Pleasure Work + Pleasure People Make the Partnership, Not Only the Institutions People Make the Partnership, Not Only the Institutions Autonomy and Freedom Autonomy and Freedom Manage Potential Differences Among Institutions Manage Potential Differences Among Institutions

38. SEDENTARYSEDENTARY SOMEWHAT ACTIVE SOMEWHAT ACTIVE REGULARLY ACTIVE VERY ACTIVE ONESTEPAHEADMODELONESTEPAHEADMODEL

39. Matsudo, Public Health Nutrition, Feb 2002 AGITA SÃO PAULO CELAFISCS

40. Matsudo, Public Health Nutrition, Feb 2002 NON - PAID MEDIA IMPACT TELEVISION TV - Lecture 240 min TV - Lecture 240 min Children Program30 min Children Program30 min Adolescent Program30 min Adolescent Program30 min Docummentary 30 min Docummentary 30 min Programs News Reports 23 flashes 245 min Onlookers21,400,000 RADIO 25 Flashes 240 min Audience 1,400,000

41. Matsudo, Public Health Nutrition, Feb 2002 Estimated People Reached Single Message 35,944,225 Saved money U$ 12,960,000 Costs of TV Program 30 sec : U$ 12,000 Money saved in TV time COMMUNITY IMPACT

42. Matsudo, Public Health Nutrition, Feb 2002 AGITOL THE FORMULA FOR ACTIVE LIVING

43. Matsudo, Public Health Nutrition, Feb 2002 Prevalence of Risk Factors São Paulo City Rego et al. Public Health Journal, 1990 Rego et al. Public Health Journal, 1990 MalesFemalesOverall %

44. Matsudo, Public Health Nutrition, Feb 2002 Prevalence of Risk Factors São Paulo City Rego et al. Public Health Journal, 1990 Rego et al. Public Health Journal, 1990 %

45. Matsudo, Public Health Nutrition, Feb 2002 How many days in a usual week do you do vigorous PA at least 10 min. ? How many days in a usual week do you do vigorous PA at least 10 min. ? % % n = 641 (312 men and 329 women / São Paulo Metropolitan Area 26.5 55.5 Days/week 12.8

46. Matsudo, Public Health Nutrition, Feb 2002 Agita America Agita America

47. Matsudo, Public Health Nutrition, Feb 2002 Agita World Agita World

48. Matsudo, Public Health Nutrition, Feb 2002 Agita São Paulo Agita São Paulo

49. Matsudo, Public Health Nutrition, Feb 2002 How many days in a usual week do you do vigorous PA at least 10 min.? How many days in a usual week do you do vigorous PA at least 10 min.? São Bernardo do Campo São Caetano do Sul Santo André % % % % % % None 1 to 4/week 5 to 7/week 54.7 26.7 14.9 60.4 26.7 9.9 50.0 25.9 14.1

50. Matsudo, Public Health Nutrition, Feb 2002 How much time do you spend per day in vigorous PA ? How much time do you spend per day in vigorous PA ? % % 0 - 40 Santo André São Bernardo do Campo São Caetano do Sul n = 641 (312 men and 329 women) Santo André São Bernardo do Campo São Caetano do Sul n = 641 (312 men and 329 women) 49.2 24.6 Minutes per day 19.9 6.0 41 - 160 161 - 360 361 - 600

51. Matsudo, Public Health Nutrition, Feb 2002 % % None 1 to 4 5 to 7 Santo André São Bernardo do Campo São Caetano do Sul n = 641 (312 men and 329 women) Santo André São Bernardo do Campo São Caetano do Sul n = 641 (312 men and 329 women) 30.5 37.4 Days per week 28.3 How many days in a usual week do you do moderate PA at least 10 min.? How many days in a usual week do you do moderate PA at least 10 min.?

52. Matsudo, Public Health Nutrition, Feb 2002 % % 0 - 40 Santo André São Bernardo do Campo São Caetano do Sul n = 641 (312 men and 329 women) Santo André São Bernardo do Campo São Caetano do Sul n = 641 (312 men and 329 women) 40.7 23.9 Minutes per day 27.1 7.2 41 - 160 161 - 360 361 - 600 How much time do you spend per day in PA moderate? How much time do you spend per day in PA moderate?

53. Matsudo, Public Health Nutrition, Feb 2002 STUDENTS PHYSICAL ACTIVTY INVOLVEMENT (%) IN VIGOROUS ACTIVITIES PRE AND POST INTERVENTION MALE FEMALE PRE INTERVENTIONPOST INTERVENTION MATSUDO, V. et al, ACSM 99 * * p <.05

54. Matsudo, Public Health Nutrition, Feb 2002 STUDENTS PHYSICAL ACTIVTY INVOLVEMENT (%) IN MODERATE ACTIVITIES PRE AND POST INTERVENTION MALE FEMALE PRE INTERVENTIONPOST INTERVENTION MATSUDO, V. et al, ACSM 99

55. Matsudo, Public Health Nutrition, Feb 2002 Agita (top of mind) X Educational Level % % 0 - 3 4 - 7 8 - 10 11 - 14 > 14 Years at school 18 48 61 64 53 Andrade, E.L. et al. Impact of a physical activity promotion program according to education years.Pre-Olympic Scientific Congress, Brisbane, Australia, 2000. Andrade, E.L. et al. Impact of a physical activity promotion program according to education years.Pre-Olympic Scientific Congress, Brisbane, Australia, 2000. n = 641 (312 men and 329 women) São Paulo Metropolitan Area n = 641 (312 men and 329 women) São Paulo Metropolitan Area

56. Matsudo, Public Health Nutrition, Feb 2002 % % 0 - 3 4 - 7 8 - 10 11 - 14 > 14 years at school 4 4 12 22 24 37 Agita Purpose X Educational Level n = 641 (312 men and 329 women) São Paulo Metropolitan Area n = 641 (312 men and 329 women) São Paulo Metropolitan Area Andrade, E.L. et al. Impact of a physical activity promotion program according to education years. Pre-Olympic Scientific Congress, Brisbane, Australia, 2000. Andrade, E.L. et al. Impact of a physical activity promotion program according to education years. Pre-Olympic Scientific Congress, Brisbane, Australia, 2000.

57. Matsudo, Public Health Nutrition, Feb 2002 Matsudo, S.M.M. et al. Impact of a physical activity promotion program on the three different communities. Pre-Olympic Scientific Congress, Brisbaine, Austrália, 2000. Matsudo, S.M.M. et al. Impact of a physical activity promotion program on the three different communities. Pre-Olympic Scientific Congress, Brisbaine, Austrália, 2000. Knowledge level about Agita Heard about program Message missing Message fine n = 641 (312 men and 329 women) São Paulo metropolitan area % % 53.0 33.5 19.5

58. Matsudo, Public Health Nutrition, Feb 2002 Matsudo, S.M.M. et al. Impact of a physical activity promotion program on the three different communities. Pre-Olympic Scientific Congress, Brisbaine, Austrália, 2000. Matsudo, S.M.M. et al. Impact of a physical activity promotion program on the three different communities. Pre-Olympic Scientific Congress, Brisbaine, Austrália, 2000. Knowledge level about Agita n = 641 (312 men and 329 women) São Paulo metropolitan area % % 47.0 33.5 19.5

59. Matsudo, Public Health Nutrition, Feb 2002 Agita Purpose X Socioeconomic Level Oliveira, L.C. et al. Level of knowledge about a physical activity program according to socioeconomic level. Pre-Olympic Scientific Congress, Brisbane, Australia, 2000. Oliveira, L.C. et al. Level of knowledge about a physical activity program according to socioeconomic level. Pre-Olympic Scientific Congress, Brisbane, Australia, 2000. % % A A B1 B2 C C D D Socio-economic level 67,6 28,8 34,4 33,8 33,3 n = 641 (312 men and 329 women) São Paulo Metropolitan Area n = 641 (312 men and 329 women) São Paulo Metropolitan Area

60. Matsudo, Public Health Nutrition, Feb 2002 Araújo, T.L. Physical activity patterns among adults in a developing country. Pre-Olympic Scientific Congress, Brisbaine, Austrália, 2000. PA pattern in adults from São Paulo metropolitan area PA pattern in adults from São Paulo metropolitan area 4 37% no register moderate PA (> 10 min.session -1 ) 4 59% envolving in moderate PA 28% moderate PA (> 5 days/week) 4 56% no register vigorous PA (> 10min.session -1 ) 4 39.0% envolving in vigorous PA (at least 10 min.session -1 ) 4 34.9% no walk in moderate step (at least 10 min.day -1 ) 4 34.8% walk > 5 days/week 4 37% no register moderate PA (> 10 min.session -1 ) 4 59% envolving in moderate PA 28% moderate PA (> 5 days/week) 4 56% no register vigorous PA (> 10min.session -1 ) 4 39.0% envolving in vigorous PA (at least 10 min.session -1 ) 4 34.9% no walk in moderate step (at least 10 min.day -1 ) 4 34.8% walk > 5 days/week

61. Matsudo, Public Health Nutrition, Feb 2002 Physical activity level Muévete Bogota 4 Physically inactive No report of any type of physical activity at least 10 minutes 4 Irregularly active Report ativity of any intensity, < 4 days per week and/or < 30 minutes/day or both 4 Regularly active Report ativity of any intensity, more than 4 days per week and more than 30 minutes per day 4 Physically inactive No report of any type of physical activity at least 10 minutes 4 Irregularly active Report ativity of any intensity, < 4 days per week and/or < 30 minutes/day or both 4 Regularly active Report ativity of any intensity, more than 4 days per week and more than 30 minutes per day

62. Matsudo, Public Health Nutrition, Feb 2002 Physical activity level - Bogota 3333 6363 44 % SedentarySedentary Irregularly active Regularly active Muévete Bogota

63. Matsudo, Public Health Nutrition, Feb 2002 63 subjects - Senior center Self-report & interview concordance Moderate PA Freq Moderate PA Freq Moderate PA Time Moderate PA Time Vigorous PA Freq Vigorous PA Freq Vigorous PA Time Vigorous PA Time Transport Freq Transport Freq Transport Time Transport Time QUESTIONQUESTION SelfSelf InterviewInterview 2.571.1457.1945.864.580.8438.4843.752.711.5637.816.992.571.1457.1945.864.580.8438.4843.752.711.5637.816.99 * p <.01 xsxsxsxsxsxsxsxsxsxsxsxs2.701.7164.4150.423.722.1262.9363.083.672.2453.929.762.701.7164.4150.423.722.1262.9363.083.672.2453.929.76.12.01.01.62*-.09.25*.12.01.01.62*-.09.25* rr

64. Matsudo, Public Health Nutrition, Feb 2002 n: 16 - Adolescents low socioeconomic region REPRODUCIBILITYREPRODUCIBILITY Moderate PA Freq Moderate PA Freq Moderate PA Time Moderate PA Time Vigorous PA Freq Vigorous PA Freq Vigorous PA Time Vigorous PA Time QUESTIONQUESTION PrePre PostPost 3.812.1984.6972.154.313.3460.1355.873.812.1984.6972.154.313.3460.1355.87 * p <.01 xsxsxsxsxsxsxsxs3.812.1769.6969.153.52.9745.1849.683.812.1769.6969.153.52.9745.1849.68.87*.82*.66*.72*.87*.82*.66*.72* rr

65. Matsudo, Public Health Nutrition, Feb 2002 MORTE TABAGISMO Boca Esôfago Pâncreas Pulmão Bexiga MMWR, 42:645-649, 1990 Homem Mulher 27,5 5,6 7,6 10,3 2,1 2,3 22,4 11,9 2,9 2,6 X X