Project GUIA Understanding and promoting physical activity in Brazil and Latin America

1. Project GUIAUnderstanding and promoting physical activity in Brazil and Latin America Eduardo Simoes, MD, MSc, MPH Director, Prevention Research Centers Program Healthy Aging Research Network Meeting March 8, 2011 National Center for Chronic Disease Prevention and Health Promotion Division of Adult and Community Health

2. Purpose of Today’s Presentation • Project GUIA: Understanding and promoting physical activity in Brazil and Latin America • www.projectguia.org • Describe the partnerships and outcomes related to Project GUIA that may be helpful to HAN members • Identify lessons learned and recommendations from the GUIA partnership

3. Context • By 2020, chronic diseases will account for 80% of deaths in developing countries (WHO) • Regular physical activity can decrease the burden of chronic disease • Physical activity interventions in Latin America have not been systematically evaluated • Methods used by CDC have applicability in Latin America • The Guide to Community Preventive Services (The Community Guide) • Observational methods

4. Why Brazil? • CDC, WHO, and World Bank global health priorities • Size, influence, and public health system • Epidemiologic, lifestyle, and demographic transitions • Potential applicability of the Community Guide to developing countries • Public health issues similar to those in other countries of the Americas • From 2005 to 2009 • Brazil’s Ministry of Health invested more than $70 million in infrastructure for surveillance, evaluation and public health programs for non-communicable diseases

5. Four Project Aims • Aim 1 (2006): • Establish and build cross-national, collaborative relationships with researchers, practitioners, and institutions in Brazil to enhance capacity to determine and implement evidence-based interventions that promote physical activity. • Aim 2 (2006): • Synthesize literature on community-based strategies to promote physical activity in Latin America. • Aim 3 (2007-2008): • Evaluate two ongoing community interventions in Brazil based on the review accomplished in Aim 2. • Aim 4 (2009): • Disseminate the products from the review process and intervention evaluations to communities, institutions, and public health professionals in Latin America.

6. Aim 1: Partnerships • Building a powerful and cohesive network for research

7. GUIA Collaborators

8. Aim 2: Systematic Review • Used Community Guide methods to conduct a review of literature published in Portuguese or Spanish

9. Very few PA intervention studies in Latin America (19) Sufficient data to recommend school PE for increasing physical activity in children in Latin America Three new community intervention types identified Informational approaches Delivery of short physical activity-related messages Behavioral and social approaches Physical activity classes in community settings Environmental and policy approaches Community-wide policy and planning Possible to carry out evidence-based reviews in Latin America Evaluation Results: Systematic Review

10. Replicating an effective program with the San Diego PRC • Evaluation results fromcommunity-wide program Academia daCidade

11. Accomplishments thus far • High quality science and publications • On par with highly-funded U.S. trials • U.S. - Brazil public health research and practice collaboration • Complex and highly effective partnerships • Universities • Public health agencies / ministries • WHO / PAHO • Leveraged funding • Not without challenges • Time & historical relationships require flexibility and trust-building

12. Lessons Learned from the Experience of Project GUIA • Suggested first steps • Experiences to repeat • Land mines to avoid

13. Questions and Discussion National Center for Chronic Disease Prevention and Health Promotion Division of Adult and Community Health