The primary and secondary objectives of this article are, respectively, to measure the effect of habitual physical activity on total medication expenditures and on expenditures specifically related to psychotropic drugs among primary healthcare users in a large Brazilian city. This cross-sectional study with a retrospective component was conducted using Propensity Score Matching (PSM). PSM is a robust and widely utilized method in studies evaluating the impact of public policies, particularly in observational data settings where randomization is infeasible. Medication expenditures and habitual physical activity data referring to the past 12 months were collected from 250 users of both sexes, aged over 40 years, across seven primary healthcare units. The average medication expenditure was USD 6.33 (95% CI: -206.64 to -31.02), and for psychotropics, USD 0.63 (95% CI: -217.75 to -11.87). The effect of physical activity on expenditures showed that more active individuals spent on average USD 34.83 less on all medications and USD 4.34 less on psychotropics compared to less active individuals. The findings of this study reinforce the importance of the physical activity as a health promotion strategy and as a means to reduce public health expenditures.

The economic impact of physical activity has been extensively investigated among adults, but few studies have analyzed this issue in pediatric populations. To analyze the relationship of costs attributed to medicine use with the time spent in different intensities of physical activity and sports participation among adolescents. A sample of 92 adolescents were tracked for 28 weeks. The main outcome was the overall cost attributed to medicine use (assessed weekly [US$]). Independent variables were moderate-to-vigorous physical activity outside sports and sportive moderate-to-vigorous physical activity, assessed in three time points (baseline, 14 weeks and 28 weeks) using accelerometers (min/day). A total of 53 boys and 39 girls, with a mean age of 14.54 (1.96) years, were evaluated. Sedentary time (rho=0.217 [95%CI: 0.006 to 0.420]) and moderate-to-vigorous physical activity+Sportive moderate-to-vigorous physical activity (- 0.250 [95%CI:-0.447 to-0.130]) were related to costs attributed to medicine use. When the multivariate model considered sedentary time as a covariate, the relationship between moderate-to-vigorous physical activity+Sportive moderate-to-vigorous physical activity and costs attributed to medicine use became non-significant (beta=- 0.007 [95%CI:-0.017 to 0.004]; p-value=0.206). The time spent in moderate-to-vigorous physical activity was inversely related to the medication costs accumulated through the follow-up period, while sedentary time appears to counteract these benefits.

INTRODUCTION:Obesity is a risk factor for the development of many chronic diseases, and, consequently, it is associated with an increase in the use of health services. On the other hand, practicing physical activity reduces healthcare costs. However, the long-term roles of physical activity and obesity in healthcare costs are not well explored in the literature. OBJECTIVE:This study aimed to investigate the physical activity (PA) and obesity trajectory in relation to health costs, in participants treated by primary care, over a period of eight years. METHODS:The sample included 291 participants, aged ≥ 50 years, evaluated between 2010 and 2018. Weight and height were used to calculate the body mass index (BMI), and PA was evaluated by a questionnaire. Healthcare costs were extracted from medical records. The General Structural Equation Model (GSEM) was used to analyze the trajectory of the variables in the eight-year follow-up. RESULTS:In 2010, the median healthcare cost was US$51.61, an increase of 54 % compared to 2018. BMI and PA decreased by around 2 % and 22.6 %, respectively. At baseline, BMI affected the trajectory of health costs, increasing costs by US$ 1.55 (p = 0.024). CONCLUSION:In conclusion, in eight years, participants presented decreases in BMI and PA and increases in health costs. BMI, but not PA, affected the increase in healthcare costs at baseline.

Background : The aim of this study was to investigate whether health care costs were influenced by trajectories of physical activity (PA) over a 10-year period. Methods : Five hundred and forty-one users of primary health care services in Brazil were followed from 2010 to 2020. PA (questionnaire) was assessed every 2 years. The score of PA was used in latent class trajectory models, and 4 trajectories were chosen: (1) low (participants who started and finished the follow-up with the lowest PA values), (2) moderate (participants who started with moderate PA levels and had a slight decrease), (3) decreasing (participants who showed a marked decrease), and (4) high (participants who started and finished with the highest PA levels). Health care costs were retrieved from medical records. Quantile regression was performed to compare costs according to trajectories of PA. Results : Median values of PA scores decreased over time in all groups, but this was more evident in the Decreasing group (54% decline). Costs in each year became more highly skewed over time, with very high maximum costs (approximately US$ 200) noted in the Low and Decreasing groups. Moderate and High groups had lower costs than the Low group in both the median and 90th percentile analyses. Using the median data, compared with costs in the Low group, costs were reduced by 26% and 43% in the Moderate and High groups, respectively. In the 90th percentile, these reductions were 48% and 55%, respectively. Conclusion : The achieving and maintaining of moderate or high PA levels over 10 years was associated with significant cost savings.

Resumo O objetivo é comparar o nível de atividade física e gastos com medicamentos de hipertensos atendidos em diferentes modalidades da atenção primária à saúde do município de Presidente Prudente. Participaram pessoas de ambos os sexos, com idade ≥ 40 anos, cadastradas em três abordagens de saúde: Unidade Básica de Saúde (UBS); Unidade Saúde da Família (USF); Unidade de Saúde da Família com Núcleo Ampliado Saúde da Família (USF+NASF). Dados sobre atividade física, doenças e gastos com medicação foram obtidos por entrevista telefônica e consulta ao prontuário eletrônico. Foram utilizados os testes qui-quadrado, Kruskal-Wallis e de regressão linear. A significância estatística adotada foi de 5%. Foram avaliadas 659 pessoas com idade média de 62 anos. Observou-se que, entre as modalidades, a presença de doenças foi maior em usuários da USF+NASF. Analisando atividade física e gastos com medicamentos, pôde-se observar relação negativa nas USF (r = -0,149; IC = -0,277 a -0,016) e USF+NASF (r = -0,210; IC = -0,334 a -0,079); após ajuste por sexo, idade, IMC e somatória de doenças, apenas a modalidade USF+NASF se manteve significante. A USF+NASF foi a única modalidade a apresentar menores gastos com medicamentos para pacientes mais ativos fisicamente, mesmo após ajuste por variáveis de confusão.

Abstract - Objective The study aimed to perform a cost-effectiveness analysis comparing the treatment based on traditional drug therapy (TDT), in relation to alternative treatment based on combined TDT and exercise program (TDT +E) in real-life condition. Methods: The health outcomes monitored during the investigation were metabolic (glucose, cholesterol, and triglycerides) and body composition (weight, body mass index [BMI] and body fat percentage [%BF]) parameters of individuals within each group. Healthcare expenditures from each participant were estimated including information registered in medical records during 12 months of follow-up. Results: The intervention group showed economic advantages in comparison to control group for triglycerides, cholesterol, weight, BMI and body fat percentage and corresponding to savings of US$7.63/mg/dL, US$5.20/mg/dL, US$31.21/kg, US$69.38/kg/m2 and US$19.32/%BF. Results were maintained even after sensitivity analyzes. Conclusions: Exercise programs might be cost-effectiveness to public health interventions among hypertensive patients in primary health care facilities, due to reduced metabolic and body composition variables, which are risk factors for chronic diseases.

ObjectivesPhysical activity and costs have been consistently related each other, but mostly in cross-sectional investigations. This study aims to investigate the relationship between changes in physical activity level and changes in healthcare costs among older diabetic adults in an 8-year follow-up study.MethodsThe study followed 151 diabetic adults ≥50 years of age, for a period of 8 years, who were patients of Basic Health Care Units in the city of Bauru (Brazil). Medical records were consulted to obtain information on healthcare costs. Physical activity level was assessed through an interview. Data analysis included descriptive statistics, analysis of variance, and linear regression.ResultsParticipants who increased leisure-time physical activity from 2010 to 2018 accumulated less healthcare costs from 2020 to 2018. The magnitude of the relationship was small (r = −0.233 [95% CI: −0.379 to −0.076]).ConclusionIn summary, among diabetic patients, to increase leisure-time physical activity from 2010 to 2018 was inversely related to the amount of healthcare costs spent over the same period of 8 years.

ABSTRACT BACKGROUND: Chronic low back pain (CLBP) is a substantial health problem that causes considerable economic losses. Several studies have demonstrated the protective effect of habitual physical activity; however, little data are available regarding its impact on the costs associated with CLBP. OBJECTIVES: The primary aim of this study was to analyze the costs of CLBP in the Brazilian Health System and associated factors among adults. DESIGN AND SETTING: An 18-month cohort study was conducted in two basic health units in Presidente Prudente (SP), Brazil. METHODS: A total of 198 patients were interviewed and evaluated four times: at baseline, with retrospective data covering the previous 12 months, and at six, 12, and 18 months. The Nordic and Baecke questionnaires were used to classify CLBP, and the Baecke questionnaire was used for physical activity assessment. The costs were calculated by reviewing the demand for services from medical records. Body mass index (kg/m2) was determined using body mass and height values collected during the interviews. The questionnaire included confounding variables, such as sex, age, ethnicity, and socioeconomic status. RESULTS: A high prevalence of CLBP was observed, which was associated with female sex and younger age. CLBP resulted in high costs for medical consultations (without: US$ 34.25 ± 23.21; with: US$ 39.62 ± 27.25; P = 0.049), while cycling was negatively associated with costs (rho = -0.289; P = 0.049). CONCLUSION: Lower back pain was associated with higher costs of medical consultations, while cycling was associated with reduced costs.

ABSTRACT BACKGROUND: Research on the economic burden of sedentary behavior and abdominal obesity on health expenses associated with cardiovascular diseases is scarce. OBJECTIVE: The objective of this study was to verify whether sedentary behavior, isolated and combined with abdominal obesity, influences the medication expenditure among adults with cardiovascular diseases. DESIGN AND SETTING: This cross-sectional study was conducted in the city of President Prudente, State of São Paulo, Brazil in 2018. METHODS: The study included adults with cardiovascular diseases, aged 30-65 years, who were treated by the Brazilian National Health Services. Sedentary behavior was assessed using a questionnaire. Abdominal obesity was defined by waist circumference. Medication expenditures were verified using the medical records of each patient. RESULTS: The study included a total of 307 adults. Individuals classified in the group with risk factor obesity combined (median [IQ] USD$ 29.39 [45.77]) or isolated (median [IQ] USD$ 27.17 [59.76]) to sedentary behavior had higher medication expenditures than those belonging to the non-obese with low sedentary behavior group (median [IQ] USD$ 13.51 [31.42]) (P = 0.01). The group with combined obesity and sedentary behavior was 2.4 (95%CI = 1.00; 5.79) times more likely to be hypertensive. CONCLUSION: Abdominal obesity was a determining factor for medication expenses, regardless of sedentary behavior, among adults with cardiovascular diseases.

Diabetes mellitus is a multiple etiology syndrome, caused by the abscense or inability of insulin to properly perform its functions in the human body.Among its complications, diabetic foot is one of the most frequent and harmful, since many of these cases eventually advance to lower limb amputation.Among the consequences caused by this surgical measure, several impacts on the patient's life were identified, such as socioeconomic, involving expensive treatment, prolonged and recurrent hospitalizations, physical and social limitations, which may lead to unemployment and reduced productivity.Through a systematic review of 10 articles, it was shown that the prevalence of amputation cases is established in male patients, at the age of 60 years or older, widowed or divorced, with incomplete formal training and low socio-demographic status.According to the review, it can be observed that factors related to trauma, improper foot care, inadequate footwear, skin irritation and ulcers are responsible for the development of diabetic foot.Moreover, it was evidenced that, among the individuals indicated for amputation, most of them already knew about their diabetes diagnosis for more than five years and others only found to have diabetic foot after the formation of foot ulcers.

A presente pesquisa transversal teve o objetivo de analisar o índice de QALY e o nível de atividade física de hipertensos cadastrados na atenção primária à saúde. A prática de atividade física foi avaliada pelo questionário de Baecke, Burema e Frijters, em que o escore foi dividido em percentis, classificando os participantes nos grupos P≥75 (mais ativos fisicamente) e P<75 (menos ativos fisicamente). O cálculo do QALY foi analisado pelo tempo despendido com hipertensão (através do inquérito de morbidades autorreferidas) multiplicado pelo valor de utilidade (analisado pelo questionário de qualidade de vida EQ-5D, do grupo EuroQoL). O QALY perdido foi analisado subtraindo o QALY pelos anos com hipertensão. Foram utilizados os testes t de Student e qui-quadrado para comparação e ANCOVA para comparações ajustadas entre os grupos. A significância estatística foi pré-fixada em valores inferiores a 5%. Foram avaliados 659 hipertensos, sendo 472 (71,6%) mulheres e 187 (28,4%) homens. Observaram-se no grupo P<75 indivíduos mais velhos (p=0,012) e maior percentual da amostra nas classes econômicas alta e baixa (p=0,011). O QALY perdido foi menor no grupo com P≥75 (p=0,011), mesmo após ajuste por fatores de confusão (p=0,009). Conclui-se que indivíduos mais ativos apresentaram melhores índices de QALY.

BACKGROUND: The magnitude of economic losses attributed to sleep problems and insufficient physical activity (PA) remains unclear. This study aimed to investigate the association between insufficient PA, sleep problems, and direct healthcare costs. OBJECTIVE: To investigate the association between insufficient physical activity (PA), sleep problems, and direct healthcare costs among adults. DESIGN AND SETTING: Adults aged >= 50 years attended by the Brazilian National Health Service were tracked from 2010 to 2014. METHODS: Direct healthcare costs were assessed using medical records and expressed in US$. Insufficient PA and sleep problems were assessed through face-to-face interviews. Differences were identified using the analysis of covariance and variance for repeated measures. RESULTS: In total, 454 women and 166 men were enrolled. Sleep problems were reported by 28.9% (95%CI: 25.2% to 32.4%) of the sample, while insufficient PA was reported by 84.8% (95%CI: 82.1% to 87.6%). The combination of sleep problems and insufficient PA explained 2.3% of all healthcare costs spent on these patients from 2010 to 2014, which directly accounts for approximately US$ 4,765.01. CONCLUSION: The combination of sleep problems and insufficient PA plays an important role in increasing direct healthcare costs in adults. Public health stakeholders, policymakers, and health professionals can use these results to reinforce the need for strategies to improve sleep quality and increase PA, especially in nations that finance their National Health Systems.

The aim is to compare the level of physical activity and medication expenditures of hypertensive patients treated in different types of primary health care in the city of Presidente Prudente. People of both sexes participated, aged ≥ 40 years, registered in three health different approaches: Primary Care, Primary Care+ e Primary Care+PE. Data on physical activity, illness and medication expenditures was obtained by telephone interview and consultation of the electronic medical record. The chi-square test, Kruskal-Wallis and linear regression were used. The statistical significance adopted was 5%. A total of 659 people were evaluated, with a mean age of 62 years. It was observed that between the modalities, the presence of diseases was higher in patients attended by the Primary Care+PE. Analyzing physical activity and medication expenses, a negative relationship can be observed in the Primary Care+ (r = -0.149; CI = -0.277 to -0.016) and Primary Care+PE (r = -0.210; CI = -0.334 to -0.079), after adjusting for gender, age, body mass index and sum of diseases, only the Primary Care+PE modality remained significant. The Primary Care+PE was the only modality to present lower expenses with medication for more physically active patients, even after adjusting for confounding variables.

Leisure-time physical activity seems relevant to prevent the development of chronic diseases and obesity. However, not much is known about the economic burden of these healthy behaviors, mainly in longitudinal designs. This study aimed to analyze the impact of walking and cycling on leisure-time on adiposity and healthcare costs among adults. This longitudinal study was conducted at a medium-size Brazilian city and included 198 participants with no missing data attended in the Brazilian Unified National Health System. Cycling and walking were assessed by a questionnaire with a face -to -face interview at four time -points (baseline, 6-month, 12-month, and 18-month). Healthcare costs were assessed using medical records. Adiposity markers included waist circumference and body fatness. Over the follow-up period, participants who were more engaged in cycling presented lower body fatness (p -value = 0.028) and healthcare costs (p -value = 0.038). However, in the multivariate model, the impact of cycling on costs was not significant (p -value = 0.507) due to the impact of number of chronic diseases (p -value = 0.001). Cycling on leisuretime is inversely related to adiposity in adults, whereas its role on preventing chronic diseases seems the main pathway linking it to cost mitigation.

BACKGROUND: The impact of metabolic syndrome (MetS) on healthcare costs remains unclear in the literature. OBJECTIVES: To determine the impact of MetS on primary healthcare costs of adults, as well as to identify the impact of physical activity and other covariates on this phenomenon. DESIGN AND SETTING: This cross-sectional study was conducted in the city of Presidente Prudente, State of S & atilde;o Paulo/Brazil, in 2016. METHODS: The sample comprised 159 older adults (> 50 years) of both sexes (110 women) who were identified from their medical records in the Brazilian National Health Service. Healthcare costs (US$) were assessed through medical records and divided into medical consultations, medications, laboratory tests, and total costs. MetS was assessed using medical records. RESULTS: The Brazilian National Health Service spent more on consultations (US$ 22.75 versus US$ 19.39; + 17.3%) and medication (US$ 19.65 versus US$ 8.32; + 136.1%) among adults with MetS than among those without MetS, but the costs for laboratory tests were similar (P = 0.343). Total costs were 53.9% higher in adults with MetS than in those without the diagnosis of the disease (P = 0.001). Regarding total costs, there was an increase of US$ 38.97 when five components of MetS were present (P = 0.015), representing an increase of approximately 700%, even after adjusting for sex, age, and physical activity. CONCLUSION: In conclusion, the presence of the MetS is responsible for increasing primary care costs among older adults, especially in those related to medicines.

A inatividade física e o alto comportamento sedentário são fatores predisponentes à doença cardiovascular e o aumento nos gastos com serviços de saúde. O estudo tem como objetivo verificar o efeito da prática de atividade física e do comportamento sedentário, de maneira isolada e agregada, sobre custos com serviços da atenção primária à saúde e a incidência de doenças ao longo de 12 meses e como elas impactam nos custos com saúde. Os custos com serviços de saúde foram verificados por meio de informações registradas nos prontuários médicos de cada paciente. Para verificar o comportamento sedentário foi utilizado o questionário de Mielke e a inatividade física foi verificada pelo questionario do Baecke. A comparação entre grupos foi verificada pelo teste de Kruskal-Wallis e Mann-Whitney. Dados categóricos foram tratados utilizando teste McNemar. O p-valor foi fixado em valores menores que 5%, e o software utilizado foi o STATA 13.0. Na primeira avaliação 18% dos avaliados foram classificadas com ≥8 horas diárias de comportamento sedentário e 74,4% cassificados <P75AFH, após 12 meses 20,3% foram classificados com ≥8 horas diárias de comportamento sedentário e 71,1% com <P75AFH. Variaçoes nos níveis de atividade física habitual e comportamento sedentário, assim como incidência de doenças, não afetaram custos com saúde da atenção primária, no entanto, aqueles classificados ≥P75AFH e <8hCS em ambos os momentos da pesquisa, apresentaram despesas inferiores com medicamentos em relação aos que apresentaram variação dessas variáveis. Esses resultados reforçam a necessidade de propostas efetivas para reduzir o tempo sedentário e aumentar a prática de atividade física, promovendo a saúde coletiva e contribuindo para a redução da morbimortalidade cardiovascular na população.

Pesquisa transversal com objetivo de analisar a associação entre qualidade de vida e comportamentos desenvolvidos por indivíduos hipertensos durante o período de isolamento social, devido à pandemia da COVID-19. O estudo foi realizado através de ligações telefônicas e avaliou adultos cadastrados na atenção primária de saúde. A prática de atividade física foi avaliada pelo Questionário Internacional de Atividade Física, sendo somadas a duração e a frequência das atividades e o tempo total sentado durante a semana e fim de semana. A qualidade de vida foi analisada através do Sistema Descritivo – EQ-5D, considerando o score utilidade e o estado geral de saúde. Presença de doenças e comportamentos durante o isolamento social, assim como aspecto emocional e ambiente para realização de atividades físicas foram analisados. Foram utilizados os testes t de Studant e ANOVA one way para comparação de grupos e ANCOVA para comparações entre os grupos ajustadas. A significância estatística foi pré-fixada em valores inferiores a 5%. Foram entrevistados 659 hipertensos, com idade entre 41 e 93 anos. Observou-se maior qualidade de vida naqueles que praticaram exercício físico (p = 0,015), que não relataram ter a saúde emocional afetada pela pandemia (p = 0,001) e que responderam ter ambiente favorável em casa para prática de atividade física, (p = 0,001). Em conclusão, a qualidade de vida associou-se aos comportamentos positivos dos participantes durante a pandemia, como a prática de atividade física, contudo é necessário que os órgãos públicos se atentem aos baixos níveis de atividade física da população provocados pela pandemia.

Background Arterial hypertension is a high prevalence disease that increase healthcare costs and affects physical activity level. This study aimed to analyse the interrelationship between arterial hypertension, health service costs, therapeutic treatment, and physical activity in patients with cardiovascular diseases. Method Cross-sectional study that evaluated 306 patients from a hospital in Presidente Prudente-Brazil. Based on their medical diagnosis, they were classified into multiple groups to access primary care and hospital-related costs variations. Then, using data from medical records and face to face interviews, they were examined on their treatment adherence and physical activity practice. Healthcare costs were accessed using medical records. Finally, the generalised linear model was used to analyse the interrelationship between treatment adherence, physical activity, health care costs and arterial hypertension. The data were analysed with Stata/MP4 16, and a p-value of less than 5% was used to determine statistical significance. Results The group that adhered to the arterial hypertension treatments but were physically inactive presented higher costs with consultation (US$=24.1, 95%CI = 1.90;46,3)​​ medication (US$=56.60, 95%CI = 1.65; 111.5) and total primary health care costs (US$=71.60, 95%CI = 19.2; 123.9) even after adjusting for confounding variables, meanwhile those participants that adhered to the treatments and were physical active did not present difference in healthcare cost when compared to normotensive and physical active participants. Conclusion To be adherent to hypertension treatment were related to higher health care costs meanwhile been physical activity were related to lower health care costs and the combination of both showed that be adherent and physical activity represent the same cost with health than those normotensive and active emphasizing the importance of adherence and physical activity in the hypertensive treatment.