Diego Augusto Santos Silva
Tiago Rodrigues de Lima- Sports Center, Department of Physical Education, Federal University of Santa Catarina, Florianopolis, Brazil
The aim of this scoping review was to map the literature related to the “Academia da Saúde” Program, including the objective and rationale of the studies, activities carried out in the program’s centers, as well as the actors involved in these actions. The search for evidence was conducted in the MEDLINE, LILACS, Web of Science, Scopus, COCHRANE, and SciELO databases. Additional evidence was investigated in the Catalog of Theses and Dissertations of the Coordination of Improvement of Higher Education Personnel (CAPES-Brazil) and in the Brazilian Digital Library of Theses and Dissertations, in addition to manual searches in the references of the studies/documents. Out of 642 initial records, the information synthesis was composed of 74 studies/documents (n = 54; 73.0% scientific articles, n = 48; 64.9% with cross-sectional design, n = 45; 60.8% quantitative analysis). Nutrition (n = 24; 32.2%) and evaluation of the Program (n = 27; 36.5%) were the main themes analyzed. Regarding the participant/object analyzed in each study, users (n = 39; 52.6%) were the main actors investigated. Future studies should consider investigating the effectiveness of the actions developed in the program centers, especially physical activity and healthy eating practices.
1. Introduction
Non-communicable diseases (NCDs) are recognized as multifactorial diseases and they are associated with modifiable risk factors (1), including smoking, excessive alcohol consumption, inadequate food intake, and physical inactivity (2). In Brazil, NCDs (i.e., cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes mellitus) are responsible for approximately 72% of all deaths (3, 4), disproportionately affecting vulnerable groups (5), such as the older adults, individuals with low income, low education, and those with limited access to public health care services (6).
In Brazil, actions and programs derived from public policies have been implemented with the objective of reducing NCDs. Among the nationally conducted actions, the Strategic Action Plan for Coping with NCDs 2011–2022 (2), developed by the Brazilian Ministry of Health, stands out. This action aims to develop and implement public policies for the prevention and control of morbidity and risk factors through the strengthening of health services (1, 2). The Strategic Action Plan for Coping with NCDs 2011–2022 is based on three main pillars: (1) surveillance, information, evaluation, and monitoring; (2) health promotion; (3) comprehensive care (1–3). Regarding health promotion, the “Academia da Saúde” Program (free translation in English: Health Academy Program) deserves attention, as the actions carried out in the program strengthen health promotion activities in Primary Care (6).
The “Academia da Saúde” Program is a continuous health promotion initiative, involving the participation and financing of municipalities, states, and the federal government (7), implemented throughout the entire Brazilian territory, making it the most comprehensive health promotion program in the country. This program includes axes/activities related to bodily practices and physical activities, production of care and healthy lifestyles, promotion of healthy eating, integrative and complementary practices, artistic and cultural practices, health education, planning and management, and community mobilization (8). Such activities are guided and supervised by qualified professionals and take place in public spaces specifically implemented (poles) for this purpose (9–11). In 2018, there were a total of 2,300 poles of the Program across the Brazil (12).
Previous studies showed that the “Academia da Saúde” Program is in line with the principles of the Brazilian health system (11), contributes to the expansion of community health promotion programs (11) and provides access to health promotion actions for the less privileged population (13). However, information regarding the description and rationale of the actions taken, impact of the activities on health indicators, and/or advances in terms of public health resulting from the “Academia da Saúde” Program are not known. Identifying and summarizing evidence related to the “Academia da Saúde” Program can contribute to the recognition of successful activities developed by the program and, thus, favor the expansion and extrapolation of such practices beyond the community or primary health care context. Preliminary searches were conducted in MEDLINE, LILACS, Web of Science, Scopus, COCHRANE, and SciELO databases; however, no scope reviews or systematic reviews with the same objective as the study were identified. While previously published review studies aimed to summarize actions developed in health promotion programs in Brazil, such as the “Academia da Saúde” Program, the present study contributes to the literature by providing information regarding the objective and rationale for conducting the original studies carried out in the centers (i.e., poles) of the “Academia da Saúde” Program.
The present scope review aimed to map the evidence related to the “Academia da Saúde” Program, including the objective and rationale of the studies, activities carried out in the program’s poles, as well as the actors involved in these actions.
2. Methods
2.1. Protocol
The present scoping review study was established based on the following research question: What evidence underlies the different stages of the “Academia da Saúde” Program? The research protocol was registered on the Open Science Framework–OSF,1 an online science sharing platform, and was developed based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes extension for Scoping Reviews - PRISMA-ScR (14) and Joanna Briggs Institute–JBI guidelines (15). The review structure followed the JBI recommended steps: (i) identification of the research question; (ii) evidence tracking related to the topic; (iii) evidence selection; (iv) in-formation analysis; (v) grouping, synthesis, and presentation of information/data.
2.2. Eligibility criteria of the study
As inclusion criteria, original quantitative or qualitative articles with cross-sectional, longitudinal, case–control, ecological, intervention, or bibliographic/documentary designs were sought. In addition, Thesis and Dissertation documents whose objective was analogous to that of this review (i.e., to present evidence related to the design, development, implementation, and conduct of activities carried out in Program) were also included. Furthermore, sources of evidence published in Portuguese, English, and Spanish were considered. Additionally, there were no restrictions on the years of data collection and publication, topics addressed, or strategies adopted in data collection and analysis. Evidence derived from review studies, monographs, thesis, dissertations, non-scientific/non-technical texts from the internet, editorials, essays, or studies not available for full access in the investigated data sources were excluded.
2.3. Selection of evidence sources
Two authors independently examined each database to identify potential studies/documents. After extracting the studies/documents from the databases, du-plicate information was excluded, and then studies/documents that did not meet the inclusion criteria previously reported were excluded after reading the titles and abstracts. Subsequently, these selected studies/documents were read in full to select the texts that would be included. Disagreements between the two reviewers were resolved through a consensus meeting. A third reviewer was consulted when disagreements/doubts regarding the studies/documents were not resolved by the reviewers. The EndNote® soft-ware version X6–(Thomson ISI ResearchSoft–Clarivate Analytics, Philadelphia, United States, 2010) was used to manage the studies/documents verified, as the functions provided by the software allow the identification and exclusion of duplicate studies, and the organization of information from each database.
2.4. Search strategies
The search for available evidence related to the theme was conducted during February 2022 in the MEDLINE, LILACS, Web of Science, Scopus, COCHRANE, and SciELO databases, based on the search strategy applied in MEDLINE: [Health gym(Text Word)] OR [Health academy(Text Word)] OR [Academia da Saúde Program(Text Word)] OR [Health Academy Program(Text Word)] AND [Brazil(Text Word)]. Additional evidence was investigated in the Catalog of Theses and Dissertations of the Coordination for the Improvement of Higher Education Personnel (CAPES)2 and in the Brazilian Digital Library of Theses and Dissertations (BDTD).3 As an additional resource, manual searches were conducted in the references of the studies/documents. Additional information regarding the evidence sources can be found in Supplementary Table S1.
2.5. Extraction and synthesis of information
Two authors conducted the extraction and synthesis of information derived from the included studies/documents, using a standardized data spreadsheet. The extracted descriptive information included characteristics of the studies/documents (place of study/document realization, publication year, number of participants, nature of the studies/documents, study/document design, and information analysis). Given that the present scope review aimed to map the literature on the Program regardless of quality, the risk of bias was not assessed (16).
The descriptive synthesis of the studies/documents included in this study followed the guidelines suggested by JBI (15), which employ three elements to guide the extraction of information: Population–information related to government agents, Program coordinators, healthcare professionals, and users; Concept–evidence related to the conception, development, implementation, and execution of activities; Context–“Academia da Saúde” Program.
After extracting the descriptive information from the included studies/documents and considering the diversity of investigated topics, it was decided to synthesize such information based on how the object of investigation of each analyzed study was related to the “Academia da Saúde” Program. In this context, seven major categories were defined: (i) information from participants was used in the investigation of different objectives and related aspects; (ii) methodological description, evaluation, and/or results of intervention programs conducted with users; (iii) spatial distribution of program units and their relationship with the food environment; (iv) quantitative and/or qualitative synthesis of actions performed, health indicators, and socioeconomic descriptors related to the program; (v) understanding and description of meanings, knowledge involved, and foundations required for the conception and/or execution of activities carried out in the program; (vi) understanding of users’ perspectives on the program and activities developed; (vii) evaluability and/or implementation of the program.
In addition to the seven major categories adopted to synthesize the diversity of investigated topics, we decided to synthesize the information considering the topics of the studies/documents according to the analyzed objects. The topics from which the information was extracted are as follows: (1) nutrition; (2) nutrition and physical activity; (3) nutrition, physical activity, and anthropometric variables; (4) nutrition and anthropometric profile; (5) physical activity; (6) program evaluation; (7) local-level instrument evaluation (i.e., assessing the validity of the investigation methods used by the study); (8) local-level program description and evaluation; (9) methodological study; (10) healthy lifestyle; (11) intervention evaluation conducted within the program context; (12) reduction of healthcare expenditures; (13) health education. Regarding the object of investigation in each analyzed study/document, eight distinct categories were identified: (a) users; (b) managers; (c) Physical Education professionals; (d) territory; (e) Health Academy Program; (f) users and territory; (g) managers and professionals; (h) managers, professionals, and users.
3. Results
The database search resulted in a total of 566 identified titles. After removing duplicates (n = 214), screening title and abstract (n = 232), and analyzing full-text articles (n = 66), 54 studies were included for information synthesis. In addition to the database search, the Catalog of Theses and Dissertations, and the BDTD were investigated to identify theses and dissertations related to the topic of interest in this review. Out of the initially identified 76 records, 27 documents were excluded for not meeting the inclusion criteria, and 29 were excluded as the analyzed information was subsequently published as a scientific article, resulting in a total of 20 documents. Therefore, a total of 74 studies/documents were included considering the different sources of information (Figure 1).
Figure 1. Flowchart of searches for documents in this scoping review.
The descriptive characteristics of the included studies/documents are described in Supplementary Table S2. Briefly, the analyzed information was mostly derived from studies conducted in the state of Minas Gerais (n = 40; 54.4%), with a growing number of publications from the biennium 2016–2017 (n = 20; 86.5%), and involving up to 99 participants (n = 20; 31.0%). Regarding the nature, design, and analysis of the information derived from the studies/documents, 73.0% (n = 54) were scientific articles, 64.9% were analyzed in a cross-sectional design, and 60.8% (n = 45) were conducted in a quantitative way, respectively.
Regarding the purpose of the included studies/documents, seven domains were identified (Table 1). Approximately one in three studies (35.1%) used information from users to investigate the association between various variables. Ten studies (13.5%) aimed to describe the methodology used, evaluate and/or present results of intervention programs conducted with users, but not related to the program itself. Analyzing the spatial distribution of program units and their relationship with the food environment was the objective of three studies (4.0%). In addition, seven studies aimed to summarize quantitatively and/or qualitatively the actions conducted, health indicators, and socioeconomic descriptors related to the program (9.5%). In addition to the aforementioned domains, understanding and describing the meanings, knowledge involved, and the necessary basis for the design and/or implementation of program activities directed the analyzes of 13 studies/documents (17.6%), while understanding users’ perceptions of the program and activities (n = 02; 2.7%) and evaluating and/or implementing the program (n = 13; 17.6%) were the basis for investigations conducted in the remaining studies/documents analyzed.
Table 1. Description of the objectives investigated in each study, according to the “Academia da Saúde” Program.
Thirteen different topics were investigated by the studies/documents included in this review. The majority of studies had Nutrition (n = 24; 32.2%) and Evaluation of the Program (n = 27; 36.5%) as their main themes. Other investigated topics were related to Nutrition and Physical Activity (n = 2; 2.7%), Nutrition, Physical Activity and Anthropometric variables (n = 2; 2.7%), Nutrition and Anthropometric Profile (n = 3; 4.1%), and Physical Activity (n = 7; 9.4%). Other topics were also investigated, including Instrument evaluation at local level (n = 1; 1.4%), Health Education (n = 1; 1.4%), Description and Evaluation of the Program at the local level (n = 2; 2.7%), Methodological study (n = 1; 1.4%), Healthy lifestyle (n = 1; 1.4%), Evaluation of a Program conducted within the context of the “Academia da Saúde” Program (n = 2; 2.7%), and Reduction of health expenses (n = 1; 1.4%; Table 2).
Table 2. Topics investigated, according to the participant/investigation object of the included studies.
Regarding the participant/object analyzed in each study, eight categories were investigated: (i) users (n = 39; 52.6%); (ii) managers (n = 6; 6.8%); (iii) Physical Education professionals (n = 5; 6.8%); (iv) territory (n = 1; 1.4%); (v) “Academia da Saúde” Program (n = 9; 12.2%); (vi) users and territory (n = 6; 8.1%); (vii) managers and professionals (n = 3; 4.0%); (viii) managers, professionals, and users (n = 6; 8.1%; Table 2).
Specific information on the studies/documents included (i.e., object of investigation, relation of the study to the review objective, topic analyzed, strategy adopted to conduct the activities, and results identified) can be found in Supplementary Table S2.
4. Discussion
As previously evidenced by studies with similar objectives and design to the present scoping review (11, 90), Nutrition and Program Evaluation were the most investigated topics by studies related to the “Academia da Saúde” Program, with the main focus of these studies being the program users. According to Article 70 of the Consolidation Ordinance No. 5, of September 28, 2017, nutrition is a component of the axis of actions (promotion of healthy eating) that guides the activities to be developed in the “Academia da Saúde” poles. The relevance of nutrition in the context of the “Academia da Saúde” Program is explained by the numerous themes related to the topic investigated by the studies, which focused on the consumption of fruits and vegetables (17, 26, 28, 29), dietary profile (27, 41), access to healthy food consumption (22, 23, 25, 30–33, 53, 54), nutritional knowledge (20, 21, 24), identification of barriers and facilitators for the intake of fruits and vegetables (18, 19, 40), and interventions aimed at promoting the intake of healthy foods (44–46). The relevance of investigating this topic by the included studies is even more understandable when considering that dietary intake has a direct relationship with the occurrence of NCDs (e.g., cancer, heart disease, and obesity) (91–93), as prevention and control of morbidities and risk factors associated with NCDs are the pillars of the creation of the “Academia da Saúde” Program (8).
The evidence synthesis revealed a high number of studies that aimed to evaluate the “Academia da Saúde” Program. It is important to highlight that this type of study allows the investigated information to be used as a management tool, contributing to decision-making regarding the actions carried out by the Program (94). In addition, despite investments in health promotion and prevention being often less costly compared to the expenses incurred with the treatment of NCDs (95), budgetary and human resource constraints available for complementary programs to primary health care actions indicate the need for evaluation of activities related to the “Academia da Saúde” Program, which may justify the high number of evidence available in the literature on this topic.
Although the “Academia da Saúde” Program was created with the objective of promoting physical practices, regular physical activity, healthy eating, health education, interdisciplinary monitoring, as well as contributing to the production of healthy and sustainable lifestyles and care for the general population7, the synthesis of information conducted in this review indicated that a large part of the studies did not address the investigation of these themes or did not report how the actions carried out in the poles translated into results for the users of the program. In this sense, in addition to systematically reporting on how activities are developed with users (e.g., type of activity, number of meetings/sessions, basis and objective of the activity carried out), it is suggested that future studies related to the “Academia da Saúde” Program aim to investigate the relationship between activities developed in the poles and the themes for which the program was created (e.g., healthy lifestyle), in order to identify successful practices and, consequently, enable their replication.
Although the extensive literature review conducted in different databases to identify the literature related to the “Academia da Saúde” Program (scientific articles, theses, and dissertations) is a strong point of the present study, some limitations need to be declared: (i) given the characteristics of the scoping review (i.e., identifying the main concepts related to a particular area of research or topic, which allows for a deeper exploration of the de-scribed information - unlike other systematic review studies, which aim to evaluate the quality of available evidence), the studies included in this review were not evaluated in terms of methodological rigor; (ii) although the strategy adopted to gather available information was comprehensive in terms of sources, it is possible that relevant studies related to the topic may not have been published in the searched databases.
We concluded that Nutrition and Evaluation of the Program were the most evaluated topics by the studies, with program users being the main actors in these investigations. Future studies should consider investigating the effectiveness of the actions developed in the program’s poles, especially physical activity and healthy eating, which are the assumptions for the creation of the “Academia da Saúde” Program.
Author contributions
DS: conceptualization, methodology, formal analysis, visualization, and writing–original draft. TL: investigation and writing–reviewing and editing. LG: investigation and writing–reviewing and editing. All authors contributed to the article and approved the submitted version.
Funding
DS was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior–Brazil (CAPES)–Finance Code 001 and he is supported in part by National Council for Scientific and Technological–CNPq, Brazil (309589/2021–5; 200636/2022–7).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material
The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2023.1227899/full#supplementary-material
Footnotes
References
1. Simões, TC, Meira, KC, Santos, J, and Câmara, DCP. Prevalências de doenças crônicas e acesso aos serviços de saúde no Brasil: evidências de três inquéritos domiciliares. Ciênc Saúde Colet. (2021) 26:3991–4006. doi: 10.1590/1413-81232021269.02982021
2. Da Saúde, BM. Plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis (DCNT) no Brasil: 2011–2022. 1st ed. Brasília, DF: Ministério da Saúde (2011). 154 p.
3. Duncan, BB, Chor, D, Aquino, EM, Bensenor, IM, Mill, JG, Schmidt, MI, et al. Doenças crônicas não transmissíveis no Brasil: prioridade para enfrentamento e investigação. Rev Saúde Pública. (2012) 46:126–34. doi: 10.1590/S0034-89102012000700017
4. World Health Organization. Noncommunicable diseases: Progress monitor 2020. Geneva: World Health Organization (2020).
5. Williams, J, Allen, L, Wickramasinghe, K, Mikkelsen, B, Roberts, N, and Townsend, N. A systematic review of associations between non-communicable diseases and socioeconomic status within low-and lower-middle-income countries. J Glob Health. (2018) 8:020409. doi: 10.7189/jogh.08.020409
6. Malta, DC, Morais Neto, OL, and Silva Junior, JB. Apresentação do plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis no Brasil, 2011 a 2022. Epidemiol Serv Saúde. (2011) 20:425–38. doi: 10.5123/S1679-49742011000400002
7. Da Saúde, BM. Redefine o Programa Academia da Saúde no âmbito do Sistema Único de Saúde (SUS). Diário Oficial da União, Brasília, DF, p. 37. (2013).
9. Guarda, F, Silva, R, Feitosa, W, Neto, PS, and Júnior, JA. Caracterização das equipes do Programa Academia da Saúde e do seu processo de trabalho. Rev Bras Ativ Fís Saúde. (2015) 20:638. doi: 10.12820/rbafs.v.20n6p638
10. De Sá, GB, Dornelles, GC, Cruz, KG, de Araújo Amorim, RC, de Araújo Andrade, SS, Oliveira, TP, et al. O Programa Academia da Saúde como estratégia de promoção da saúde e modos de vida saudáveis: cenário nacional de implementação. Ciênc Saúde Colet. (2016) 21:1849–60. doi: 10.1590/1413-81232015216.09562016
11. Silva, AG, Prates, EJS, and Malta, DC. Avaliação de programas comunitários de atividade física no Brasil: uma revisão de escopo. Cad Saúde Pública. (2021) 37:e00277820. doi: 10.1590/0102-311x000277820
12. Mota, PHS, Viana, ALÁ, and Bousquat, A. Relações federativas no Programa Academia da Saúde: estudo de dois municípios paulistas. Saúde. Debate. (2016) 40:64–73. doi: 10.1590/0103-1104-20161080005
13. Ivo, AMS, Malta, DC, and Freitas, MIF. Modos de pensar dos profissionais do Programa Academia da Saúde sobre saúde e doença e suas implicações nas ações de promoção de saúde. Physis. (2019) 29:e290110. doi: 10.1590/s0103-73312019290110
14. Tricco, AC, Lillie, E, Zarin, W, O'Brien, KK, Colquhoun, H, Levac, D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. (2018) 169:467–73. doi: 10.7326/M18-0850
15. Peters, MD, Godfrey, CM, McInerney, P, Soares, CB, Khalil, H, and Parker, D. The Joanna Briggs institute reviewers' manual 2015: Methodology for JBI scoping reviews. Adelaide: The Joanna Briggs Institute (2015).
16. Peters, MD, Godfrey, C, McInerney, P, Baldini Soares, C, and Khalil, H. Scoping reviews In: E Aromataris and Z Munn, editors. JBI manual for evidence synthesis. Adelaide: Joanna Briggs Institute (2017). 1–24.
17. Figueira, TR, Lopes, ACS, and Modena, CM. Avaliação do consumo de frutas e hortaliças entre famílias de usuários do Programa Academia da Saúde (PAS). Rev Bras Promoção Saúde. (2014) 27:518–26. doi: 10.5020/18061230.2014.p518
18. Figueira, TR, Lopes, ACS, and Modena, CM. Promoters and barriers to fruit and vegetable consumption among health academy Program's users. Rev Nutr. (2016) 29:85–95. doi: 10.1590/1678-98652016000100009
19. Guimarães, LMF. Elementos facilitadores e dificultadores da adesão a ações de incentivo ao consumo de frutas e hortaliças. Dissertação de mestrado. Belo Horizonte: Universidade Federal de Minas Gerais, Escola de Enfermagem (2016).
20. Machado, CH, Lopes, ACS, and Santos, LC. Misreporting of energy intake among users of Health Promotion Services/Notificação imprecisa da ingestão energética entre usuários de Serviços de Promoção à Saúde. Ciênc Saúde Colet. (2017) 22:417–26. doi: 10.1590/1413-81232017222.21492015
21. Carvalho, MCR, Menezes, MC, and Lopes, ACS. Perception versus intake of fruit and vegetables. Rev Nutr. (2018) 31:221–33. doi: 10.1590/1678-98652018000200008
22. Menezes, MC, Roux, AVD, and Lopes, ACS. Fruit and vegetable intake: influence of perceived food environment and self-efficacy. Appetite. (2018) 127:249–56. doi: 10.1016/j.appet.2018.05.011
23. Menezes, MC, Roux, AVD, Costa, BVDL, and Lopes, ACS. Individual and food environmental factors: association with diet. Public Health Nutr. (2018) 21:2782–92. doi: 10.1017/S1368980018001623
24. Jorge, LDS, Santos, CAD, and Haraguchi, FK. Health academy program: association of nutritional knowledge and anthropometric parameters. Mundo Saúde. (2018) 42:728–43. doi: 10.15343/0104-7809.20184203728743
25. Mendonça, RDD, Lopes, MS, Freitas, PP, Campos, SF, Menezes, MC, and Lopes, ACS. Monotony in the consumption of fruits and vegetables and food environment characteristics. Rev Saúde Pública. (2019) 53:63. doi: 10.11606/S1518-8787.2019053000705
26. Silva, SLR. Interferentes no consumo de frutas e hortaliças de usuários do Programa Academia da Saúde. Dissertação de mestrado. Belo Horizonte: Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Nutrição e Saúde (2019).
27. Silva, AR, Lopes, MS, Campos, SF, Santos, LCD, Freitas, PP, and Lopes, ACS. Dietary and nutrient intake among participants of a Brazilian health promotion program: a cross-sectional study. Public Health Nutr. (2021) 24:6218–26. doi: 10.1017/S1368980021002330
28. Costa, GAM, Lopes, MS, and Lopes, ACS. Fruit and vegetable consumption across generations of primary Brazilian care users. Nutr. (2022) 93:111435. doi: 10.1016/j.nut.2021.111435
29. Araújo, ML. Repercussão da segurança alimentar e nutricional sobre o consumo de frutas e hortaliças. Dissertação de mestrado. Belo Horizonte: Universidade Federal de Minas Gerais, Escola de Enfermagem (2016).
30. Costa, BVDL, Menezes, MC, Oliveira, CDL, Mingoti, SA, Jaime, PC, Caiaffa, WT, et al. Does access to healthy food vary according to socioeconomic status and to food store type? An ecologic study. BMC Public Health. (2019) 19:775. doi: 10.1186/s12889-019-6975-y
31. Freitas, PP, de Menezes, MC, and Lopes, ACS. Consumer food environment and overweight. Nutrition. (2019) 66:108–14. doi: 10.1016/j.nut.2019.04.013
32. Horta, PM, Souza, JPM, Freitas, PP, and Lopes, ACS. Food availability and advertising within food outlets around primary healthcare services in Brazil. J Nutr Sci. (2020) 9:e44. doi: 10.1017/jns.2020.45
33. Lopes, MS, Caiaffa, WT, Andrade, ACS, Malta, DC, Barber, S, and Friche, AAL. Disparities in food consumption between economically segregated urban neighbourhoods. Public Health Nutr. (2020) 23:525–37. doi: 10.1017/S1368980019003501
34. Lopes, ACS, Toledo, MTT, Câmara, AMCS, Menzel, H-JK, and Santos, LC. Condições de saúde e aconselhamento sobre alimentação e atividade física na Atenção Primária à Saúde de Belo Horizonte-MG. Epidemiol Serv Saúde. (2014) 23:305–16. doi: 10.5123/S1679-49742014000300010
35. Bessa, FG. Consumo de micronutrientes de usuários das academias da saúde de Belo Horizonte: caracterização e possível associação com o estado nutricional [dissertação]. Belo Horizonte: Universidade Federal de Minas Gerais (2017).
36. Freitas, PP. Impacto de intervenção nutricional, pautada no modelo transteórico para controle de peso, na atenção primária: ensaio clínico controlado randomizado [dissertação]. Belo Horizonte: Universidade Federal de Minas Gerais (2015).
37. Freitas, PP, Mingoti, SA, and Lopes, ACS. Validação do peso autorreferido entre usuários do Programa Academia da Saúde de Belo Horizonte, Minas Gerais, 2017. Epidemiol Serv Saúde. (2020) 29:e2019368. doi: 10.5123/S1679-49742020000300010
38. Lopes, MS. Validade relativa de métodos de avaliação do consumo de frutas e hortaliças [dissertação]. Belo Horizonte: Universidade Federal de Minas Gerais (2015).
39. Mendonça, RD, Lopes, MS, Carvalho, MCR, Freitas, PP, and Lopes, ACS. Adherence to healthy lifestyles in the Programa academia da Saúde. Rev Bras Ativ Fís Saúde. (2020) 25:1–9. doi: 10.12820/rbafs.25e0127
40. Faria, TMTR, Brenner, S, Deckert, A, Florindo, AA, and Mielke, GI. Health academy program and physical activity levels in Brazilian state capitals. Rev Bras Ativ Fis Saúde. (2020) 25:1–8. doi: 10.12820/rbafs.25e0133
41. Silva, CO, de Freitas, PP, dos Santos, LC, and Lopes, ACS. Consumo alimentar segundo o recebimento de orientação nutricional em participantes do Programa Academia da Saúde. Rev Bras Ativ Fis Saúde. (2020) 25:1–10. doi: 10.12820/rbafs.25e0170
42. Lima, RCF, Rodrigues, BLS, Farias, SJM, Lippo, BRDS, and Guarda, FRB. Impacto do Programa Academia da Saúde sobre gastos com internações hospitalares por doenças cerebrovasculares. Rev Bras Ativ Fis Saúde. (2020) 25:1–8. doi: 10.12820/rbafs.25e0166
43. De Deus Mendonça, R, Guimarães, LM, Mingoti, SA, Magalhães, KA, and Lopes, AC. Barriers to and facilitators for adherence to nutritional intervention: consumption of fruits and vegetables. Nutrition. (2019) 67–68:110568–8. doi: 10.1016/j.nut.2019.110568
44. Carvalho, MCR, Menezes, MC, Toral, N, and Lopes, ACS. Does misperception of fruit and vegetable intake adequacy affect progression through the stages of behavior change after nutritional intervention? Appetite. (2020) 151:104693:104682. doi: 10.1016/j.appet.2020.104682
45. Carvalho, MCR, Menezes, MC, Toral, N, and Lopes, ACS. Effect of a transtheoretical model-based intervention on fruit and vegetable intake according to perception of intake adequacy: a randomized controlled community trial. Appetite. (2021) 161:105118:105159. doi: 10.1016/j.appet.2021.105159
46. Mendonça, RD, Mingoti, SA, Bethony, MFG, Martinez-Gonzalez, MA, Bes-Rastrollo, M, and Lopes, ACS. Intervention for promoting intake of fruits and vegetables in Brazilians: a randomised controlled trial. Public Health Nutr. (2022) 25:781–93. doi: 10.1017/S1368980021004341
47. Meurer, ST, Lopes, ACS, Almeida, FA, Mendonça, RD, and Benedetti, TRB. Effectiveness of the VAMOS strategy for increasing physical activity and healthy dietary habits: a randomized controlled community trial. Health Educ Behav. (2019) 46:406–16. doi: 10.1177/1090198118820095
48. Meurer, ST, Borges, LJ, Gerage, AM, Lopes, ACS, and Benedetti, TRB. Promotion of physical activities and healthy eating habits in primary care: maintenance of benefits. Rev Nutr. (2020) 33:e190126. doi: 10.1590/1678-9865202033e190120
49. De Deus, RM, Mingoti, SA, Jaime, PC, and Lopes, AC. The impact of a nutritional intervention on the nutritional status and anthropometric profile of participants in the health gym programme in Brazil. Cienc Saude Colet. (2015) 20:1937–46. doi: 10.1590/1413-81232015206.11882014
50. Menezes, MC, Mendonça, RD, Ferreira, NL, Guimarães, LMF, and Lopes, ACS. Promoting fruit and vegetable consumption: methodological protocol of a randomized controlled community trial. Contemp Clin Trials Commun. (2018) 10:131–6. doi: 10.1016/j.conctc.2018.04.003
51. Quadros, EN, Maciel, EC, Konrad, LM, Ribeiro, CG, Lopes, ACS, Meurer, ST, et al. Evaluating the effectiveness of program vamos in the context of program academy of health: a qualitative study. Movimento. (2020) 26:e26023. doi: 10.22456/1982-8918.94432
52. Arakaki, EHH. Academia da Saúde como recurso comunitário para o bem-estar e inclusão na psicose: efeitos de um programa de atividade física ao ar livre [dissertação]. Campo Grande, Mato Grosso do Sul: Universidade Católica Dom Bosco (2019).
53. Costa, BVL, Oliveira, CDL, and Lopes, ACS. Food environment of fruits and vegetables in the territory of the health academy program. Cad Saude Publica. (2015) 31:159–69. doi: 10.1590/0102-311X00027114
54. Menezes, MC, Costa, BVL, Oliveira, CDL, and Lopes, ACS. Local food environment and fruit and vegetable consumption: an ecological study. Prev Med Rep. (2017) 5:13–20. doi: 10.1016/j.pmedr.2016.10.015
55. Costa, BVL, Freitas, PP, Menezes, MCD, Guimarães, LMF, Ferreira, LDF, Alves, MDSC, et al. Ambiente alimentar: validação de método de mensuração e caracterização em território com o Programa Academia da Saúde. Cad Saude Publica. (2018) 34:e00168817. doi: 10.1590/0102-311X00168817
56. Florindo, AA, Nakamura, PM, Júnior, JCF, Siqueira, FV, Reis, RS, Cruz, DKA, et al. Promoção da atividade física e da alimentação saudável e a saúde da família em municípios com academia da saúde. Rev Bras Educ Fís Esp. (2016) 30:913–24. doi: 10.1590/1807-55092016000400913
57. Tusset, D, Santos, LD, Merchan-Hamann, E, and Calmon, PCDP. Programa Academia da Saúde: correlação entre internações por doenças crônicas não transmissíveis e adesão nos municípios brasileiros, 2011-2017. Epidemiol Serv Saúde. (2020) 29:e2019453. doi: 10.1590/s1679-49742020000500013
58. Rodrigues, BLS, Silva, RN, Arruda, RG, Silva, PBC, Feitosa, DKDS, and Guarda, FRB. Impacto do Programa Academia da Saúde sobre a mortalidade por Hipertensão Arterial Sistêmica no estado de Pernambuco. Brasil Ciênc Saúde Colet. (2021) 26:6199–210. doi: 10.1590/1413-812320212612.32802020
59. Florindo, AA, Reis, RS, Junior, JCF, Siqueira, FV, Nakamura, PM, and Hallal, PC. Description of health promotion actions in Brazilian cities that received funds to develop “academia da Saúde” program. Rev Bras Cineantropom Desempenho Hum. (2016) 18:483–92. doi: 10.5007/1980-0037.2016v18n4p483
60. Ferreira, HJ, Kirk, D, and Drigo, AJ. Qualitative analysis of the health promotion work in a academia da Saúde programme’s unit. Rev Bras Ativ Fís Saúde. (2020) 25:1–9. doi: 10.12820/rbafs.25e0172
61. Ferreira, MSM. Assistência ao idoso na atenção básica: um estudo do programa Academia da Saúde, com evidências do PMAQ-AB 2012 e 2014 [dissertação]. Rio de Janeiro: RJ. Mestrado em Saúde Pública. Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca (2018).
62. Silva, CRM. Promoção da atividade física para adolescentes: avaliação das intervenções realizadas na atenção básica à saúde no estado de Pernambuco [dissertação]. Camaragibe (PE): Universidade de Pernambuco (2016).
63. Skowronski, M. Educação física e saúde: a mobilização de saberes para atuação nos polos do programa academia da saúde no Brasil [dissertação]. Florianópolis (SC): Programa de Pós-Graduação em Educação Física, Universidade Federal de Santa Catarina (2014).
64. Prass, PBB. Atuação dos Profissionais de Educação Física no Programa Academia da Saúde: Mobilização de Saberes e Contexto [dissertação]. Porto Alegre (RS): Universidade Federal do Rio Grande do Sul (2017).
65. Ivo, AMS, Viana, VC, and Freitas, MIF. Health academy program: importance for users and funding difficulties. Rev Bras Ativ Fís Saúde. (2020) 25:1–9. doi: 10.12820/rbafs.25e0169
66. Corrêa, FG. Academia da Saúde: sentidos produzidos sobre a relação entre corpo, sujeito e estado [dissertação]. Cáceres, Mato Grosso: Universidade do Estado de Mato Grosso (2019).
67. Padilha, MA. Análise do Programa Academia da Saúde à luz dos pressupostos teóricos e metodológicos da promoção da saúde [dissertação]. Rio de Janeiro: Rio de Janeiro. Mestrado em Saúde Pública. Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (2016).
68. Andrade, ABOC. Avaliação da qualidade do instrumento de avaliação para monitoramento de gestão do programa academia da saúde [dissertação]. Rio de Janeiro: Faculdade Cesgranrio (2017).
69. Silva, AO. Programa Academia da Saúde: aproximações entre promoção da saúde e educação [dissertação]. Goiânia: Universidade Federal de Goiás (2017).
70. Guarda, FRB, Silva, RN, Feitosa, WMN, Neto, PMS, and Júnior, JLACA. Characterization of physical activity program teams and their work process. Rev Bras Ativ Fís Saúde. (2015) 20:638–46. doi: 10.12820/rbafs.v.20n6p638
71. Guarda, F, Silva, R, Feitosa, W, Farias, J, Neto, P, and Junior, JLAC. Self-perception of the objective, object and work products of physical education professionals belonging to the academia da Saúde program. Rev Bras Ativ Fís Saúde. (2016) 21:400–9. doi: 10.12820/rbafs.v.21n5p400-409
72. Gonçalves, LBB, Almeida, RC, Oliveira, TM, Palácio, MAV, and Pinto, AGA. Programa academia da saúde: operacionalidade, ações e integração. Rev Bras Promoç Saúde. (2019) 32:1–9. doi: 10.5020/18061230.2019.7781
73. Reis, GA. Programa academia da saúde: análise do processo pedagógico de educação permanente desenvolvido na formação presencial aplicada no estado do Tocantins [Dissertação]. Palmas: Universidade Federal do Tocantins (2020).
74. Paiva Neto, FT, Mazo, GZ, Sandreschi, PF, Petreça, DR, and Rech, CR. Barriers to implementation of academia da Saúde program in Santa Catarina. J Phys Educ. (2019) 30:e3046. doi: 10.4025/jphyseduc.v30i13046
75. Lucetti, MDL, Santana, VVF, Vidal, ECF, Filho, JAS, and Pinto, AGA. Users’ perception of the community Centers for physical activity from two cities in Ceará, Brazil. ABCS Health Sci. (2020) 45:1–7. doi: 10.7322/abcshs.45.2020.1266
76. Ruas, RFB. Representações de usuários do programa academia da saúde sobre promoção da saúde e prevenção de doenças [dissertação]. Belo Horizonte: Universidade Federal de Minas Gerais (2016).
77. Silva, RN. Avaliabilidade do Programa Academia da Saúde no Recife: um estudo de Caso [dissertação]. Recife: Pernambuco. Saúde Coletiva. Universidade Federal de Pernambuco (2015).
78. Tusset, D, Olkoski, M, Merchan-Hamann, E, Calmon, PCDP, and Santos, L. Programa Academia da Saúde: um olhar quantitativo das adesões entre 2011 a 2017. Rev Bras Ativ Fís Saúde. (2020) 25:1–9. doi: 10.12820/rbafs.25e0165
79. Guarda, FRB, Carneiro, RCBD, Silva, RN, Pinto, FCM, Loch, MR, and Florindo, AA. Analysis of the degree of implementation of health academy program in a Brazilian midsize town. Cad Saude Publica. (2021) 37:e00075020. doi: 10.1590/0102-311x00075020
80. Mota, PHS. A configuração do programa academia da saúde como estratégia para a promoção à saúde [dissertação]. São Paulo: São Paulo. Medicina Preventiva. Universidade de São Paulo (2015).
81. Sá, GBAR, Dornelles, GC, Cruz, KG, Amorim, RCA, Andrade, SSCA, Oliveira, TP, et al. The health academy program as a strategy to promote health and healthy lifestyles: the national implementation scenario. Cien Saude Colet. (2016) 21:1849–60. doi: 10.1590/1413-81232015216.09562016
82. Mota, PHS, Viana, AL, and Bousquat, A. Federative relations at the Programa academia da Saúde (health academy program): study of two cities of the state of São Paulo. Saude Debate. (2016) 40:64–73. doi: 10.1590/0103-1104-20161080005
83. Manta, SW, Sandreschi, PF, Tomicki, C, Konrad, LM, Quadros, EN, Ribeiro, CG, et al. Monitoring the health academy program from 2015 to 2017. Rev Andal Med Deporte. (2020) 13:16–20. doi: 10.33155/j.ramd.2019.09.003
84. Parreira, FR. Conhecimento e subjetividades: a [re] construção da promoção da saúde no Programa Academia da Saúde, no estado de Goiás [dissertação]. Goiânia: Goiás. Universidade Federal de Goiás (2019).
85. Maciel, MG, Saraiva, LAS, Silva, MM, and Junior, PRV. Performance evaluation of the health gym program in Belo Horizonte: a case study. Mov. (2019) 25:e25026. doi: 10.22456/1982-8918.88631
86. Pereira, JLS. Análise da implementação das ações de incentivo à atividade física no âmbito da política de promoção da saúde no município de Goiânia-Goiás [dissertação]. Goiânia: Goiás. Centro Universitário Alves Faria (2017).
87. Fernandes, AP, Andrade, ACS, Costa, DAS, Dias, MADAS, Malta, DC, and Caiaffa, WT. Health academies program and the promotion of physical activity in the city: the experience of Belo Horizonte, Minas Gerais state, Brazil. Cienc Saude Colet. (2017) 22:3903–14. doi: 10.1590/1413-812320172212.25282017
88. Silva, RN, Guarda, FRB, Hallal, PC, and Martelli, PJL. Evaluability of the health gym program in Recife, Pernambuco state, Brazil. Cad Saude Publica. (2017) 33:e00159415. doi: 10.1590/0102-311X00159415
89. Silva, RN, Oliveira, JR, Carneiro, RCB, Farias, SJM, and da Guarda, FRB. Avaliação do grau de implantação do Programa Academia da Saúde no município de Bezerros, Pernambuco. Rev Bras Ativ Fís Saúde. (2020) 25:1–10. doi: 10.12820/rbafs.25e0170
90. Guerra, PH, Andrade, DR, Rodriguez-Añez, CR, Santos, DL, de Camargo, EM, Fermino, RC, et al. Research on the academia da Cidade and academia da Saude programs: scoping review. Rev Bras Ativ Fis Saude. (2020) 25:1–6. doi: 10.12820/rbafs.25e0180
91. Mayne, ST, Playdon, MC, and Rock, CL. Diet, nutrition, and cancer: past, present and future. Nat Rev Clin Oncol. (2016) 13:504–15. doi: 10.1038/nrclinonc.2016.24
92. Stanner, S, Coe, S, and Frayn, KN. Cardiovascular disease: Diet, nutrition and emerging risk factors. New York: John Wiley & Sons (2018).
93. Hruby, A, Manson, JE, Qi, L, Malik, VS, Rimm, EB, Sun, Q, et al. Determinants and consequences of obesity. Am J Public Health. (2016) 106:1656–62. doi: 10.2105/AJPH.2016.303326
94. Almeida, DB, and Melo, CMM. Avaliação na atenção básica em saúde: uma revisão de literatura. Rev Baiana Enferm. (2010) 24:55–64. Available at: https://periodicos.ufba.br/index.php/enfermagem/article/view/5530/3983
Keywords: public health, nutrition, health promotion, physical activity, population health
Citation: Silva DAS, de Lima TR and Gonçalves L (2023) “Academia da Saúde” program: mapping evidence from the largest health promotion community program in Brazil. Front. Public Health 11:1227899. doi: 10.3389/fpubh.2023.1227899
Edited by:
Michael Long, Oklahoma State University, United StatesReviewed by:
Rita de Cássia Akutsu, University of Brasilia, BrazilCopyright © 2023 Silva, de Lima and Gonçalves. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Diego Augusto Santos Silva, ZGllZ29hdWd1c3Rvc3NAeWFob28uY29tLmJy