Youth knowledge of physical activity health benefits: a Brazilian case study.

Abstract

This study presents the findings of a questionnaire-based investigation of knowledge about the relationship of physical activity to health among adolescent participants of a community-based physical activity intervention program in São Paulo, Brazil. Qualitative (inductive content analysis) and quantitative methods were applied to examine the participants' responses to two open-ended questions concerning the health benefits of physical activity and the educational goals of the intervention. More than 75% of all participants stated that health benefits (of some type) are attained through participation in physical activity. More than 50% of participants reported that the goal of the intervention was to educate people about the importance of a healthy, active lifestyle. Adolescents understand the relationship of physical activity to health as reflected in their knowledge assessments; their lifestyle choices support these beliefs. These findings offer encouragement for the development and implementation of educationally oriented interventions aimed at providing physical activity information and programming.

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Research Article
TheScientificWorldJOURNAL (2006) 6, 1713–1721
ISSN 1537-744X; DOI 10.1100/tsw.2006.283


*Corresponding author.
©2006 with author.
Published by TheScientificWorld, Ltd.; www.thescientificworld.com


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Youth Knowledge of Physical Activity Health
Benefits: A Brazilian Case Study
Susan Gail Zieff*, Claudia Maria Guedes, and James Wiley
Department of Kinesiology and Public Research Institute, San Francisco State
University, San Francisco, CA
E-mail: susangz@sfsu.edu
Received November 15, 2006; Revised December 2, 2006; Accepted December 2, 2006; Published December 28, 2006
This study presents the findings of a questionnaire-based investigation of knowledge about
the relationship of physical activity to health among adolescent participants of a
community-based physical activity intervention program in São Paulo, Brazil. Qualitative
(inductive content analysis) and quantitative methods were applied to examine the
participants’ responses to two open-ended questions concerning the health benefits of
physical activity and the educational goals of the intervention. More than 75% of all
participants stated that health benefits (of some type) are attained through participation in
physical activity. More than 50% of participants reported that the goal of the intervention
was to educate people about the importance of a healthy, active lifestyle. Adolescents
understand the relationship of physical activity to health as reflected in their knowledge
assessments; their lifestyle choices support these beliefs. These findings offer
encouragement for the development and implementation of educationally oriented
interventions aimed at providing physical activity information and programming.
KEYWORDS: adolescent, physical activity, health knowledge, Brazil

INTRODUCTION
Inadequate participation in health-related physical activity (PA) among adults and children has become a
global phenomenon occurring in industrialized, developing, and third-world countries[1,2,3,4,5]. Decreasing
rates of PA and increasing amounts of time spent in sedentary pursuits are also contributing to rapidly
growing numbers of obese children and teenagers[6] who face potentially decreased life expectancy as
adults[7,8]. Declines in PA participation typically begin in late childhood, accelerate during high school, and
continue into the adult years, creating the context for ill health among adults[4,5]. Consequently, late
childhood and adolescence are critical periods for the acquisition of both healthy and unhealthy behaviors[3].
High levels of childhood PA have been shown to predict for high levels of adult PA[5,9], as well as reduce
the biological risk factors that are likely to impair health in adults[4,10].
Physical Activity Knowledge and Behavior
Among the intervention programs designed to increase PA among children and adolescents, few offer an
educational component linking behavior change to knowledge gain about specific ways to change and the
important reasons for change. A growing body of evidence suggests that among adults, exposure to

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information about the health benefits of PA positively influences lifestyle changes[11]. Morrow et al.[12]
suggest that PA knowledge would be more effective if individuals are able to identify specific PA behaviors
considered useful for improving health. Yet, the high number of inactive adults also suggests that health
information without advice about effective strategies for changing behavior is only minimally effective[12].
In one of few studies of the health information–behavior change relationship among adolescents, Simon
et al.[13] demonstrated that after a 6-month intervention aimed at changing attitudes about PA, middle
school students showed a significant improvement in PA patterns. However, before we can know if acquired
information leads to behavior change in youth, we need to investigate if and how adolescents understand
information emphasizing the role of PA in improving health. Many of the interventions in the literature have
focused on elementary school children, with a resulting lack of information about the particular issues facing
middle school students[14]. Few interventions report long-term behavioral change or contribute to our
understanding of why the number of sedentary youth continues to increase, suggesting that such strategies
need to be more effective[7,14].
The general objective of this study was to identify how youth understand and articulate health-related
messages promoted by the PA intervention program, Agita Galera, the adolescent segment of the
community-based, health program “Agita São Paulo” in the State of São Paulo, Brazil.
METHODS
In 1996, the Physical Fitness Research Center from São Caetano do Sul (CELAFISCS) and the Office of the
State Secretary of Health in São Paulo, Brazil established a multilevel program, “Agita São Paulo” (ASP) to
provide information about the health benefits of PA and to coordinate related events and interventions for the
more than 37 million inhabitants of the State of São Paulo[1]. ASP emphasizes the focused message
“Physical Activity is Health: Accumulate 30 Minutes per Day,” following the then-published guidelines of
the American College of Sports Medicine and the CDC (Centers for Disease Control and Prevention)[1,15].
Agita Galera (AG) is the youth segment of ASP. A “mega-event” for AG is held annually, with typical
participation from over 6,500 schools and 6 million students, to raise awareness about the importance of an
active lifestyle and to model the kinds of activities and events provided within local communities[1]. In
addition, media announcements, advertisements, school lectures, and printed materials containing
information about the health benefits of PA are provided to children attending schools participating in
AG[16]. Through its design as a year-round program distributing educational items (videos, posters, stickers,
games) to the involved schools, AG spreads its message of health-related PA[17].
The specific purpose of this research was twofold: (1) to determine how youth participants in a
community-based, PA intervention program (AG) understand and communicate about the importance of PA
in relation to health and (2) to determine if the participants understand that the message about the health
benefits of 30 min of daily PA is the program’s educational objective.
A 22-item questionnaire was developed for internal consistency reliability and therefore included different
questions measuring the same phenomenon[18]. The design of this tool included seven descriptive, closed-
ended demographic questions (e.g., sex, age, school grade) and 15 open-ended questions. Seven of these open-
ended questions asked about participants’ PA history and current behavior and eight questions investigated the
participants’ conceptual understanding of the connections between PA and health (see Box). In addition, this
project used a “grounded theory” design in which the researchers enter the research setting without a
predetermined theory, instead allowing the data collected to determine the theory outcomes[18]. Open-ended
questions provide the opportunity for participants to share their knowledge and experiences with few
limitations imposed by the researchers. Both qualitative and quantitative data analysis methods were used to
identify, discuss, and measure exemplary and illustrative responses to selected open-ended

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BOX 1
Selected Questionnaire Items about Physical Activity History and Behavior
1. Is physical activity important? Why?
2. Do you engage in physical activity? How many times per week? How many minutes per day?
3. Do you practice physical activity alone or with others?
4. What type of physical activity do you practice?
5. Where do you practice your physical activity?
6. When you are physically active, for how many minutes?
7. How many minutes do you dedicate to practicing physical activity per week outside of school physical education?
8. What are the objectives of Agita Galera?
questions and to assess participants’ current PA as active members of AG. These methods were chosen on
the assumption that better results can be achieved through investigations that integrate frequency of
responses and analysis of meaning in the process of interpreting data and developing conclusions.
This study presents the findings of a questionnaire-based investigation of knowledge about the
relationship of PA to health among adolescents who participated in AG, a PA event held in 2004 in São
Paulo, Brazil.
Procedures
Twenty-three undergraduate research assistants and eight graduate research coordinators received 12 h of
training in research techniques including participant recruitment, questionnaire delivery, and issues of
professional responsibility. The San Francisco State University Institutional Review Board for the Protection
of Human Subjects reviewed and approved the project. Informed consent forms were distributed to
prospective research participants on-site and questions about the process were answered. Consent forms and
completed questionnaires were coded to protect the identities of the participants.
The questionnaire was delivered on-site in Parque Chico Mendes, in Sao Caetano, a suburb of the city of
Sao Paulo, during the AG mega-event on August 27, 2004 involving five schools. All youth participants in
AG ages 14–18 were eligible to complete the questionnaire. The research assistants distributed themselves
throughout Chico Mendes Park from 8 a.m. until 4 p.m. delivering the questionnaire to 255 of the
approximately 300 participants (i.e., as many as possible and as time permitted), using random and snowball
recruitment methods.
Participants
Inclusion criteria for the participants were as follows: age 14–18 years and involved in AG. N = 55 received
a consent form and were interviewed using the questionnaire. N = 22 were removed from analysis when they
were found to not be involved in AG, leaving approximately 77% of the total number of participants for data
analysis. The adolescent sample of participants in our study was predominantly male (59%), white (69%),
and age 16 or under (82%).
These participants present a relatively high rate of PA (Table 1). The mean number of PA sessions is
3.7/week, and 60% of the sample reported three or more sessions per week, meeting and in many cases,
exceeding, the minimum recommended by the CDC and ACSM[19]. The CDC and ACSM also recommend

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TABLE 1
Physical Activity Indicators
N %
1. Number of sessions of PA per week
0–1
2
3–5
6+

18
73
88
52
231

25
77
90
39
231
N
136
52
34
9
231

92
43
39
26
31
231

24
7.8
31.6
38.1
22.5
100.0

10.8
33.3
39.0
16.9
100.0
%
58.9
22.5
14.7
3.9
100.0

39.8
18.6
16.8
11.2
13.4
100.0

26.1
Total
2. Average number of minutes per week
30 min or less
31–60
61–120
More than 120 min
Total
3. Types of PA
Team sports
Fitness activities
Martial arts/dance
Other (e.g., skateboarding, ping pong, surfing)
Total
4. Participation rates for AG
1st time
2nd time
3rd time
4th time
5–11 times
Total
5. Age in relation to first time in AG
14
15
16
17–18
33
22
13
92
35.9
23.9
14.1
100.0 Total
a minimum of 30 min of PA per activity day, a standard reached by 89% of the participants. Over 60% of
participants demonstrated an adherence to the AG program, having attended mega-events two or more times.
The number of PA sessions and minutes per day were achieved through activities defined as “vigorous” rather
than “lifestyle” or “moderate” PA[19,20] including team sports (e.g., soccer, volleyball, basketball), fitness
(e.g., body toning classes, calisthenics, jogging), martial arts and dance (street dance, kung fu, capoeira), and
other activities (e.g., ping pong, surfing, skateboarding).
Data Analysis
Inductive Content Analysis (ICA) was used to analyze the selected open-ended questions (Table 2). ICA
follows a multiphase process and allows for multiple responses[21]. First responses have value independent

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of other responses and are presented in the data analyzed here. However, first or more frequent responses do
not necessarily hold the most important value[22].
TABLE 2
Inductive Content Analysis Procedures
Process Outcome
Translate and transcribe raw data
Development of themes from transcribed responses
Independent assignment of first responses to themes
by two researchers
Consensus categories and first response
assignments
Frequency distributions of third-level themes
Comparisons of theme, age, and gender frequency
over subgroups
Identify frequent responses
First-level themes
Second-level themes
Second-level themes confirmed, retained as third-level
themes
Evaluate themes with highest frequency
Evaluation of differences and their significance
The process began with the two researchers, (both bilingual readers of Portuguese and English),
translating and transcribing verbatim the complete response of each participant and entering these onto an
Excel spreadsheet. Then, using the words of the participants (raw data), frequently appearing responses were
identified and counted. From this preliminary analysis, first level themes were developed. “Theme” is the
term used in ICA to indicate a grouping of responses that are interpreted and then coded to have similar
meaning. Then, independently, the researchers coded the raw data for each response to the two selected
open-ended questions using the first-level themes. These codes are labeled second-level themes. The level of
intercoder reliability[23] at this stage of coding was quite high: kappa = 0.809, p < 0.001, for adjusted
intercoder agreement in assigning first responses to the seven thematic categories associated with the open-
ended question “Is Physical Activity Important? Why?”; kappa = 0.913, p < 0.001, for adjusted intercoder
agreement in assigning first responses to the four thematic categories associates with the open-ended
question “What are the objectives of Agita Galera?”
The researchers then rejoined to compare their assignment of second-level themes. Second-level themes
that were agreed became third-level themes and preserved for continued analysis. Where different themes
were coded for any specific response, the researchers re-examined the original text and negotiated about the
interpretation of the data before performing the final coding of the themes. The themes are allowed to
emerge directly from the text-based data, and represent it, as closely as possible. This procedure allows for
the development of progressively inductive categories paralleling the reductive process of the text
interpretation[21].
In the final stage of data interpretation, quantitative analyses of the coded themes were conducted. We
examined frequency distributions of themes based on first responses and compared the relative frequency of
themes in different subgroups of participants.
RESULTS
The results of the ICA of the two selected open-ended questions are reported here: (1) “Is physical activity
important? Why?” and (2) What are the objectives of AG? Typical responses for each subtheme are included
below to demonstrate both the range of issues reported and to provide examples of participant responses.
From a review of the responses to the first question, seven themes emerged (Table 3A). Almost half of
the participant first responses addressed specific health benefits of PA and included references to
enhancement of the physiological system, the avoidance of disease, preservation of health, and improving