RESUMO
OBJECTIVES: The effectiveness of community level interventions depends to a great extent on adherence. Currently, information on factors related to adherence in older adults from developing countries is scarce. Our aim was to identify factors associated to adherence to a physical activity intervention in older adults from a post-transitional middle income country. DESIGN, SETTING AND PARTICIPANTS: Using a combination of quantitative and qualitative methods we studied 996 older Chilean subjects (65-67.9 years at baseline) with low to medium socioeconomic status from 10 health centers randomized to receive a physical activity intervention as part of the CENEX cluster trial (ISRCTN48153354). MEASUREMENTS: Using a multilevel regression model, the relationship between adherence (defined a priori as attendance at a minimum of 24 physical activity classes spread over at least 12 months) and individual, intervention-related and contextual factors was evaluated. We also conducted 40 semi-structured interviews with older adults (n=36) and instructors (n=4). Transcripts of the interviews were analyzed using content analysis to identify barriers and facilitators to adherence. RESULTS: Adherence to physical activity intervention was 42.6% (CI 95% 39.5 to 45.6). Depression, diabetes mellitus, percentage of impoverished households and rate of arrests for violent crimes in the neighborhood predicted less adherence (p<0.05) while being retired, participation in physical activity prior to the intervention, and green areas per habitant were positively associated with adherence (p<0.05). The qualitative interviews identified three primary barriers to adherence: current health problems, lack of time due to commitments for caring for family members, and being employed, and two primary facilitators to adherence: the health benefits attributed to the intervention and the opportunity the classes provided for social interaction with others. CONCLUSION: In order to enhance effectiveness of community exercise interventions, strategies to improve participation should be targeted to older adults from deprived areas and those with psychological and medical conditions.
Assuntos
Emprego , Exercício Físico , Família , Nível de Saúde , Cooperação do Paciente , Pobreza , Características de Residência , Idoso , Cuidadores , Chile , Crime , Países em Desenvolvimento , Meio Ambiente , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Relações Interpessoais , Entrevistas como Assunto , Masculino , Satisfação do Paciente , Pesquisa Qualitativa , Análise de RegressãoRESUMO
PRIMARY OBJECTIVE: To describe the upper- and lower-body growth of two populations of lowland Amazonian Amerindian children. RESEARCH DESIGN AND METHODS: The stature and sitting height of a convenience sample of 659 Patamona and 543 Wapishana children of known ages between 0 and 16 years of age was collected using standard techniques. Subischial leg length was calculated as stature less sitting height. The raw data were compared with reference data of British children, and body segment z-score values were calculated. RESULTS: The data suggest that Amerindian children were significantly shorter than their British contemporaries, and that considerable faltering in total stature occurred by the third year of life. However, there were contrasting patterns of faltering in the upper and lower body which may well reflect differences in the tempo of growth of body segments at different ages. The two study populations differed significantly in their total stature and this was shown to be due to significant differences in leg length but not in sitting height. CONCLUSIONS: The adverse effects on childhood growth of poor environmental conditions are well known, and it is argued that the variation in body size found between the populations in this study were the results of marked differences in the quality of their living conditions. This paper provides baseline data on the growth of Amerindian populations that are currently facing unprecedented changes in their economic and environmental circumstances.