1. Victor Matsudo Lighting the Fire The Brazil Experience Barbados March 6th, 2009 Active Caribbean Workshop 2009 Road to the Wellness Revolution matsudo@celafiscs.org.br

3. “The Samba – Caribbean Connection”.

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

5. 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

6. 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

7. CELAFISCS Family !

8. We have a dream

18. - Agita São Paulo - Agita São Paulo CELAFISCSCELAFISCS Physical Activity Caloric Intake 3000 Kcal d -1 2100 Kcal d -1 1000 Kcal d -1 300 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

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

20. Monteiro & Matsudo, Pan American Journal Public Health, 14(4):246-253,2003 Any Leisure-Time Physical Acitvity According to Socio-Economic Level

21. Education n: 11.033 – H: 5234 / M: 5799 – > 20 anos 4.800 – Home-Interview Monteiro C, Matsudo S, 2003 Gender and Educational Level & Probability of engaging in any LTPA OR

22. World deaths in 2000 attributable to selected leading risk factors 2 Million Deaths Number of deaths (000s) Sedentarism WHO, 2005

23. 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

24. The Science The Science

25. Do Scientific Evidences Change Behavior ? Do Scientific Evidences Change Behavior ?

26. Morris et al. 1953 Angina Incidence (1949-1950) Cardio-vascular deathes Total

27. 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 (%) 60 65 70 75 80 85 90 Age in Years 35 YEARS OF FOLLOW-UP 2.205 HOMENS Born Between 1920 and 1924 Cohort Uppsala Longitudinal Study of Adult Men (ULSAM) 1612840 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

28. 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):1094:1100,2007 2.205 HOMENS Born Between 1920 and 1924 Cohort Uppsala Longitudinal Study of Adult Men (ULSAM)

29. P for Trend = 0.014 Harzad Ratios Associations Between Breast Cancer Outcomes and Physical Activity 2 Years After Diagnosis 0.21 - 0.78 0.15 - 0.61 0.17 - 0.73 0.15 - 0.73 P for Trend = 0.046 Irwin et al, J Clin Oncol 26:3958-3964, 2008 933 women x Age= 55.5 59% 70% 64% 67%

30. (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) :112-119 Relative Risk of Gastric and Esophagic Carcinoma According to Physical Actitivty Cohort 487.732 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

31. Total: 8940 10 years: 5284 5 years: 3224 last yr: 645 Humans: 7774 10 years : 4646 5 years: 2814 last yr: 511 Bergamaschi, J. May 30th, 2007 Publications on P.A.& CVD

32. Matsudo, V Sea Pines Course, 2003 7080 1960 Physical Activity 90 2000 Published Papers Physical Activity Academic Paradox

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

34. www.agitasp.org.br Medical Perspective (Disease) Drugs Surgery

35. www.agitasp.org.br Pharmacological Determinism Surgery Determinism

36. www.agitasp.org.br Building Health !

37. WILLIAMS, P.T. Med.Sci.Sports Exerc. 40(3):433-443,2008 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 <5 5-1415-2425-3435-44 45+ Walking distance(km) <1.2 1.2-1.51.5-1.81.8-2.1>2.1 Walking speed (m/s)

38. EXER STENT “STENT” or PHYSICAL ACTIVITY SURVIVAL EXERCISE

39. www.agitasp.org.br Building Health through Physical Activity ! Physical Activity !

40. www.agitasp.org.br Mental Health Diet Physical Activity

41. www.agitasp.org.br Building Health through Healthy Behaviors

42. www.agitasp.org.br Physical Activity Diet Mental Health (No Tabaco/ Alchool)

43. www.agitasp.org.br Building Health Surgery Drugs

44. The Vision Putting Theory and Practice in one Sentence !

45. Knowledge Management Knowledge Management

47. 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 248.808. km2 Area: 248.808. km2 Cities: 645 Some Partners of Agita São Paulo

48. 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

49. 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

50. 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

51. Partnership Executive Board Meeting

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

53. AMAPÁ

54. Clear Message ! Clear Message !

56. Moderate PA Works ! Moderate PA Works !

58. RISK OF DEATH X TOTAL ENERGY EXPENDITURE Kj.wk -1 RR 20% Kj.wk -1 RR  % % < 42001.0 referência0 4200 - <8400 0.80 (0.72 – 0.88) - 20 8400 - <12600 0.74 (0.65 – 0.83) - 26 12600 - < 16800 0.80 (0.69 – 0.93) - 20  16800 0.73 (0.64 – 0.84) - 27  LEE et al., Am J Epidemiol, 2000 p < 0,001 27% 74% 26% 96% Observational Cohort Study 13.485 Men ; 2.539 Deathes