Intervenções de exercício físico e fatores de risco cardiovasculares em usuários da Atenção Primária à Saúde

Abstract

Cardiovascular diseases are the main causes of death in the world, however, they are preventable. Primary Health Care (PHC) aims to program health actions and disease prevention focusing on determinants such as physical activity (PA) through interventions, which are increasingly present. It is essential to assess the effectiveness of interventions and the participation of the population. This dissertation was written in article format, with the general objective of evaluating the effect of physical exercise interventions on risk factors related to cardiovascular diseases in PHC users and the following specific objectives: a) systematically search and synthesize the evidence available in the literature about the effect of physical exercise interventions in PHC, on cardiovascular and cardiometabolic parameters, carried out in Brazil; b) to evaluate the effect of the volume of participation in a physical exercise program offered in the PHC, for 24 weeks, on blood biochemical parameters. In article 1, for the systematic search, the PubMed, Virtual Health Library and Web of Science databases were used. DeCS was used to define the best descriptors: “physical activity” OR “exercise” OR “motor activity” AND “primary health care” OR “health centers” OR “primary care” AND “Brazil”. All phases were performed in pairs and blinded, and conflicts were decided by a third evaluator. For methodological quality, the Jadad scale was used. 1,817 articles were found and 27 duplicates were excluded, leaving 1,791 for reading the titles (1,686 excluded); 105 for reading the abstracts (52 excluded); 53 for full reading (47 excluded); 06 articles were considered eligible and included in the systematic review. It is concluded that there are few studies available in the literature about physical exercise interventions in PHC carried out in Brazil, and consequently inconclusive evidence on the benefits of physical exercise on cardiovascular health within this context. In article 2, to assess the effect of volume of participation, a study was carried out with 53 individuals who completed 24 weeks of intervention, regardless of the number of absences. The volume of participation was calculated according to the duration of the sessions and the number of classes held by each individual, forming groups according to quartiles: Low Volume Group (LVG; n=13), Low Medium Volume Group (LMVG; n=13), Medium High-Volume Group (MHVG; n=14) and High-Volume Group (HVG; n=13). Blood biochemical analysis was performed using the ELISA method. The Generalized Estimation Equation Model (GEE) was used to compare the biochemical parameters (p≤0.05). The analysis showed a significant effect of time for total cholesterol (TC), low-density lipoproteins (LDL) and glycemia in all groups and a significant effect of the group for TC (HVG regarding to all groups) and LDL (HVG regarding to LVG and LMVG). It is concluded that the physical exercise program offered in the PHC contributed to a significant reduction in LDL and blood glucose levels, regardless of the volume of participation of individuals in the program.