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The correlates of meeting physical activity recommendations: A population-based cross-sectional study a

a

a

b

a

Adilson Marques , João Martins , José Diniz , Madalena Ramos , Flávia Yazigi , Marcos a

Onofre & Francisco Carreiro da Costa

a c

a

Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics , Technical University of Lisbon , Cruz Quebrada , Portugal b

Centre for Research and Studies in Sociology (CIES-IUL), School of Sociology and Public Policy , University Institute of Lisbon , Lisbon , Portugal c

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Faculty of Physical Education and sport , Lusophone University of Humanities and Technologies , Lisbon , Portugal Published online: 07 Aug 2012.

To cite this article: Adilson Marques , João Martins , José Diniz , Madalena Ramos , Flávia Yazigi , Marcos Onofre & Francisco Carreiro da Costa (2014) The correlates of meeting physical activity recommendations: A population-based cross-sectional study, European Journal of Sport Science, 14:sup1, S462-S470, DOI: 10.1080/17461391.2012.713008 To link to this article: http://dx.doi.org/10.1080/17461391.2012.713008

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European Journal of Sport Science, 2014 Vol. 14, No. S1, S462
S470, http://dx.doi.org/10.1080/17461391.2012.713008

ORIGINAL ARTICLE

The correlates of meeting physical activity recommendations: A population-based cross-sectional study

´ DINIZ1, MADALENA RAMOS2, ˜ O MARTINS1, JOSE ADILSON MARQUES1, JOA ´ VIA YAZIGI1, MARCOS ONOFRE1, & FRANCISCO CARREIRO DA COSTA1,3 FLA

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1

Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, Technical University of Lisbon, Cruz Quebrada, Portugal, 2Centre for Research and Studies in Sociology (CIES-IUL), School of Sociology and Public Policy, University Institute of Lisbon, Lisbon, Portugal, and 3Faculty of Physical Education and sport, Lusophone University of Humanities and Technologies, Lisbon, Portugal

Abstract The aim of this study was to identify correlated factors which explain the recommended level of leisure time physical activity (LTPA) among Portuguese adults. Subjects aged 31
60 years (972 males, 1195 females) were categorized, based on LTPA data obtained using a questionnaire, into two groups according to the PA recommendation for PA: ]10 or B10 MET ×hr ×wk 1. Chi-square and logistic regression analyses were applied to the results. For men, the perception of an active lifestyle [odds ratio (OR)  4.61, 95% CI:3.13
6.81, p B 0.001], having an excellent perception of health (OR  3.14, 95% CI:1.28
7.71, p  0.013), perception of being sufficiently active (OR  2.16, 95% CI:1.53
3.05, p B 0.001), and having a high socio-economic status (SES) (OR  1.86, 95% CI:1.22
2.81, p  0.004) were associated with attaining the recommended level of PA. For women, the perception of an active lifestyle (OR  3.68, 95% CI:2.63
5.15, p B 0.001), and middle SES (OR  1.50, 95% CI:1.07
2.11, p  0.018) were positive and associated with meeting PA recommendations. Unlike men, women with body mass index (BMI) 25
29.9 kg/m2 were more likely to attain the recommended level of PA than those with BMI B25 kg/m2. The incidence of adults that met the recommended amount of PA is low. Men and women had different patterns of psychological and sociodemographic correlates. An intervention designed to improve the levels of PA among Portuguese adults may take these correlates into account.

Keywords: Physical activity, lifestyle, recommendation, adults

Introduction The influence of physical activity (PA) on chronic disease prevention and increasing longevity has been well established (Lee & Paffenbarger, 1996; Lee, Sesso, Oguma, & Paffenbarger, 2004). Several studies have established an inverse relationship between an active lifestyle and the risk of illness or death (Lee et al., 2004; Schnohr, Scharling, & Jensen, 2003; Tanasescu et al., 2002). Therefore, promoting engagement in regular PA is considered a crucial step for public health, preventing a wide range of chronic diseases (Lee, Sesso, Oguma, & Paffenbarger, 2003; Motl, Birnbaum, Kubik, & Dishman, 2004; Zhang et al., 2010).

Despite evidence of the health benefits of PA, many people do not exercise enough to benefit their health (Martinez-Gonzalez et al., 2001). Because of the high prevalence of inactivity, several statements have been made to demonstrate the importance of leisure time PA (LTPA) in promoting health. The Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) recommend that adults should perform at least 30 minutes of moderate PA (MPA) 5 days per week, or 20 minutes of vigourous PA (VPA) at least 3 days per week (Pate et al., 1995). This recommendation emphasizes the benefits of moderate intensity and provides an innovative

Correspondence: A. Marques, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, Technical University of Lisbon, Estrada da Costa, 1499-002 Cruz Quebrada, Portugal. E-mail: [email protected] # 2013 European College of Sport Science

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The correlates of PA: a population-based study aspect related to the accumulation of PA throughout the day. Recently, the American Heart Association and ACSM joined a panel of experts in order to update and clarify the existing recommendation (Haskell et al., 2007). The specialists confirmed the guidance included in the 1996 Surgeon General’s Report (USDHHS, 1996), while placing greater emphasis on the benefits associated with combining moderate and vigourous activities. They have also specified that every adult should perform, at least twice a week, activities that maintain or increase muscular strength and muscular endurance. Knowing that the percentage of the Portuguese population that practises regular PA is among the lowest in the European Union (European-Commision, 2010; Martinez-Gonzalez et al., 2001; Varo et al., 2003), it is important to understand the factors related to the practice of those who meet the PA recommended level in their LT. A better understanding of the contributing factors that influence LTPA is critical in designing policies and effective interventions because it allows researchers to pay attention to modifying factors. Although there are several studies on the correlates of PA from other countries (Chen et al., 2011; Dowda, Ainsworth, Addy, Saunders, & Riner, 2003; Shibata, Oka, Nakamura, & Muraoka, 2009), studies have shown that the correlates of PA (at work, commuting or in LT) differ across countries (Martinez-Gonzalez et al., 2001). Apart from those studies reported, it must be emphasized that quantitative research exploring the correlates of meeting PA recommendations among adults is still rather limited in Portugal. The study of socio-demographic variables related to LTPA, such as gender, age, socio-economic status (SES), and educational level can help to identify subgroups for intervention programmes (Belanger, Townsend, & Foster, 2011; Dowda et al., 2003; Kamphuis et al., 2009). Since variables associated with LTPA differed between normal weight, overweight and obese people (Hallal et al., 2008; Hallal, Victora, Wells, & Lima, 2003), studies on LTPA correlates might benefit from differentiation of the subjects by body mass index (BMI). Finally, understanding the association of self-perceptions with engagement in LTPA is essential since studies have shown its importance (Bergman, Grjibovski, Hagstromer, Bauman, & Sjostrom, 2008; Kruger, Bowles, Jones, Ainsworth, & Kohl, 2007; Sodergren, Sundquist, Johansson, & Sundquist, 2008). Therefore, the aim of this study was to identify the correlated factors associated with meeting the recommended levels of PA in LT in a sample of Portuguese adults.

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Methods Participants The participants were 2166 adults (972 male and 1194 female) aged 31
60 years old (43.496.0). These subjects took part in a study of their lifestyles, as parents, and teachers of students from six schools in the Lisbon Metropolitan Area. The study received approval from both the National Commission for Data Protection and the Ethics Committee of theFaculty of Human Kinetics of the Technical University of Lisbon. Measures of physical activity LTPA was assessed by a self-report questionnaire. All participants were asked to report the details of their LTPA, including the activities, duration of each session and frequency (sessions per week). In total, there were 22 activities adapted from Telama et al. (2002). The test
retest reliability of the LTPA activities was carried out within one-week interval across 100 participants. Using intraclass correlation coefficient (ICC), the reliability was high (ICC  0.90
0.95). A metabolic equivalent (MET) value was assigned to each reported LTPA. The activities were classified as light (B3 METs), moderate (3
6 METs) and vigourous (6 METs) (Ainsworth et al., 2011). Based on the recommendation of CDC/ACSM (Haskell et al., 2007; Pate et al., 1995), the participants were considered as meeting the recommendation if they reported engaging in MPA ]5 days per week for ]30 minutes each day and/or VPA ]3 days per week for ]20 minutes each day, or both, achieving at least 10 MET-minute hr wk 1. Participants who reported some activity but at a lower level than the recommended were classified as not meeting the recommendation. Body mass index BMI was calculated from self-reported height and weight (kg/m2) and participants were divided into three BMI categories in accordance with the World Health Organization guidelines (WHO, 2000): normal weight (18.5 to B25 kg/m2), overweight (25
29.9 kg/m2) and obese (]30 kg/m2). Socio-demographic variables Socio-demographic variables included gender, age, SES and educational level. Age was divided into the following age groups  31
40, 41
50 and 51
60 years old. SES was based on occupation and educational level. Occupation titles were regrouped in order to classify the subjects as lower, middle and

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upper class. The lower class included skilled and unskilled manual workers, farmers and fishermen; the middle, service occupations, such as non-professional health service workers, office clerks and salespeople; the upper, business-owners, executives, university-educated specialists and professionals (Raudsepp & Viira, 2000). The educational level was based on the Portuguese educational system and grouped into three categories: 9 years of education or less (lower), 10
12 years of education (middle) and more than 12 years (high).

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Perceptions Perception of lifestyle was measured by only one question: ‘How do you classify your own lifestyle?’ Responses were given using a five-point scale ranging from (1) ‘sedentary’ to (5) ‘very active’. Points 1 and 2, and 4 and 5 were combined and three groups were made: sedentary or less active, sufficiently active and active or very active. Perception of health was assessed with one item using a three-point scale (‘I am not feeling healthy’, ‘I am in reasonable health’ and ‘I am feeling very healthy’). Procedures Teachers’ and parents’ questionnaires were completed by self-administration. Each teacher received an envelope containing a questionnaire and a letter explaining the purpose of the study and asking for a return of the completed questionnaire within 2 days. Parents received an envelope containing two questionnaires and a letter explaining not only the objectives of the study, but also how to complete the questionnaire. The children returned their parents’ questionnaires. Statistical analysis Bivariate relationships between LTPA (meeting PA recommendation vs. not meeting PA recommendation in LT) and age, SES, educational level, BMI, lifestyle perception and self-rated health were tested by chi-square test. Independent effects of each independent variable on the categories of LTPA were assessed by a logistic regression. Unadjusted and adjusted odds ratio (OR) with 95% confidence intervals (CI) were calculated. Adjustments were performed for all studied variables. The OR were calculated against the reference categories of subjects aged 31
40 years old, lower SES, those with basic education, BMI B25 kg/m2, having a perception of sedentary or less active lifestyle, and poor self-rated health. An OR greater than one reflects an increased likelihood of the recommended level of PA. The analyses were

stratified by gender. All statistical analysis was performed using IBM SPSS Statistics 19.0. The significance level was set at p B0.05. Results The general sample’s characteristics are presented in Table I. The proportion of the total subjects who achieved the recommended PA levels in their LT (MPA ]5*30 min/wk and/or VPA ]3*20 min/wk, or both, achieving at least 10 MET-minute hr wk 1) was 33%, 32.8% male and 33.1% female. Women slightly surpassed men but there was no association between gender and LTPA (X2(1) 0.017, p  0.897). In general, 53.6% were overweight or obese, and the percentage of men (67%) was higher than women (42.7%) with significant differences (X2(2) B 129.012, pB0.001). About half of the respondents perceived to have a sufficiently or highly active lifestyle (51.8%). On the other hand, the other half perceived themselves as less active or sedentary (48.2%). Table I also shows the data regarding selfrated health, noting that the vast majority reported having excellent or reasonable health (93.5%). Table II shows the comparison of socio-demographic characteristics and correlates of LTPA between the two groups with different levels of LTPA according the PA recommendations. The subjects that meet PA recommended guidelines in LT account for a large percentage in the highest SES for men (X2(2) 14.064, p 0.001) and middle SES for women (X2(2) 7.337, p 0.026). BMI B25 kg/m2 were associated with meeting LTPA recommendations among men (X2(2)  8.589, p 0.014). In addition, men and women who meet the PA recommendations during LT were likely to have a better perception of their lifestyle (men X2(2)  84.480, p B0.001; women X2(2) 83.866, p B 0.001), and they evaluated their health status positively (men X2(2) 33.535, p B0.001; women X2(2) 10.621, p 0.005). There were no significant differences related to age or educational level, for both genders. However, the proportion of older subjects who attained the PA recommendation in LT is higher than younger subjects. Table III shows the results of the unadjusted logistic regression analysis. For men, those with middle SES (OR 1.47, 95% CI:1.04
2.06, p  0.028), high SES (OR 1.88, 95% CI:1.35
2.62, p B0.001), perception of a sufficiently (OR 2.37, 95% CI:1.70
3.31, p B0.001) and active lifestyle (OR 5.08, 95% CI:3.55
7.27, p B 0.001), and reporting having excellent (OR 2.54, 95% CI:1.05
6.14, p B0.001) or reasonable health (OR  2.54, 95% CI:1.05
6.14, p  0.038) had a higher and significant tendency for meeting PA recommendation in LT. Also in this

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Table I. General characteristics of the study population by gender Total sample (n 2166)

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Characteristic Physical activity Do not meet the recommendations Meet the recommendations Age groups 31
40 41
50 51
60 SES Lower Middle High Educational level Lower Middle High BMI (kg/m2) B 25 25
29.9 ] 30 Perception of lifestyle Sedentary/less active Sufficiently active Active/very active Self-rated health Poor Fair Excellent

Women (n 1194)

Men (n 972)

n

%

n

%

n

%

1452 714

67.0 33.0

653 319

67.2 32.8

799 395

66.9 33.1

0.897

725 1163 278

33.5 53.7 12.8

270 550 152

27.8 56.6 15.6

455 613 126

38.1 51.3 10.6

B0.001

667 783 716

30.8 36.1 33.1

328 313 331

33.7 32.2 34.1

339 470 385

28.4 39.4 32.2

0.001

1158 494 514

53.5 22.8 23.7

522 219 231

53.7 22.5 23.8

639 275 283

53.3 23.0 23.7

0.961

1006 905 255

46.4 41.8 11.8

321 516 135

33.0 53.1 13.9

685 389 120

57.4 32.6 10.1

B0.001

1045 652 469

48.2 30.1 21.7

413 332 227

42.5 34.2 23.4

632 320 242

52.9 26.8 20.3

B0.001

140 919 1107

6.5 42.4 51.1

51 387 534

5.2 39.8 54.9

89 532 573

7.5 44.6 48.0

0.003

crude analysis, men with BMI 25
29.9 kg/m2 (OR 0.69, 95% CI:0.51
0.92, p 0.011) and BMI ]30 kg/m2 (OR 0.59, 95% CI:0.38
0.92, p  0.019) were significantly less likely to be physically active at the recommended level than those with BMI B25 kg/m2. For women, middle SES (OR 1.40, 95% CI:1.04
1.89, p  0.026), middle level of education (OR  1.41, 95% CI:1.05
1.89, p  0.023), perception of a sufficiently (OR  3.01, 95% CI:2.25
4.03, p B0.001) and active lifestyle (OR 3.39, 95% CI:2.47
4.65, p B0.001), were significantly associated with meeting PA recommendations during LT. Table IV presents the result of the adjusted regression analysis. For men, the perception of an active lifestyle (OR  4.61, 95% CI:3.13
6.81, p B 0.001) was the strongest positive association with attaining the recommended level of PA in LT followed by having an excellent perception of health (OR 3.14, 95% CI:1.28
7.71, p  0.013), perception of being sufficiently active (OR  2.16, 95% CI:1.53
3.05, p B 0.001), and having a high SES (OR 1.86, 95% CI:1.22
2.81, p 0.004). To have a middle SES, BMI ]30 kg/m2, and report a fair health status failed to remain significant after adjusting variables. For women, perception of an active lifestyle (OR  3.68, 95% CI:2.63
5.15,

p

p B 0.001) was also the strongest positive association with meeting PA recommendations during LT. Those with middle SES (OR 1.50, 95% CI:1.07
2.11, p 0.018) are still more likely to be physically active at the recommended level than those with lower SES. However, the educational level was no longer significant (considering a 0.05 level). Unlike men, women with BMI 25
29.9 kg/m2 were more likely to attain the recommended level of PA in LT than those with BMI B25 kg/m2.

Discussion This study examined the socio-demographic, BMI and cognitive factors related with meeting the recommended levels of PA during LT among a sample of Portuguese adults. The result shows that 33% of the study participants are physically active and achieved the PA recommended levels during LT. This is similar to findings observed in developed countries (Belanger et al., 2011; Burton & Turrell, 2000; Shibata et al., 2009), but higher than in some developing countries (Ku, Fox, McKenna, & Peng, 2006; Trinh, Nguyen, Dibley, Phongsavan, & Bauman, 2008). This difference may reflect the availability of and accessibility to PA recreational activities in developed countries,

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Table II. The characteristic of subjects that meet and do not meet PA recommendations by gender Men

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Characteristic

Do not meet the recommendations (%)

Age groups 31
40 41
50 51
60 SES Lower Middle High Educational level Lower Middle High BMI (kg/m2) B 25 25
30 ] 30 Perception of lifestyle Sedentary/less active Sufficiently active Active/very active Self-rated health Poor Fair Excellent

Women

Meet the recommendations (%)

p

Do not meet the recommendations (%)

Meet the recommendations (%)

p

28.8 55.9 15.3

25.7 58.0 16.3

0.596

38.4 52.2 9.4

37.5 49.6 12.9

0.172

37.4 31.9 30.8

26.3 32.9 40.8

0.001

29.7 36.7 33.6

25.8 44.8 29.4

0.026

56.0 21.3 22.7

48.9 25.1 26.0

0.110

55.1 21.2 23.8

49.6 26.8 23.5

0.75

30.0 55.0 15.0

39.2 49.2 11.6

0.014

58.8 31.4 9.8

54.4 34.9 10.6

0.351

51.3

24.5

B.001

62.2

34.2

B0.001

32.8

37.0

22.0

36.5

15.9

38.6

15.8

29.4

6.9 44.3 48.9

1.9 30.7 67.4

8.0 47.3 44.7

6.3 39.0 54.7

B0.001

0.005

Table III. Associations between socio-demographic variable, BMI, lifestyle and health perceptions and meeting PA recommendations Meeting PA recommendations Men Explanatory variables Age groups 31
40 41
50 51
60 SES Lower Middle High Educational level Lower Middle High BMI (kg/m2) B 25 25
29.9 ] 30 Perception of lifestyle Sedentary/ less active Sufficiently active Active/very active Self-rated health Poor Fair Excellent

Unadjusted OR (95% CI)

Women p

Unadjusted OR (95% CI)

p

1.00 (ref) 1.16 (0.85
1.59) 1.19 (0.78
1.82)

0.348 0.416

1.00 (ref) 0.98 (0.75
1.26) 1.41 (0.94
2.12)

0.848 0.097

1.00 (ref) 1.47 (1.04
2.06) 1.88 (1.35
2.62)

0.028 B0.001

1.00 (ref) 1.40 (1.04
1.89) 1.00 (0.73
1.38)

0.026 0.990

1.00 (ref) 1.35 (0.97
1.88) 1.32 (0.95
1.83)

0.077 0.101

1.00 (ref) 1.41 (1.05
1.89) 1.10 (0.81
1.48)

0.023 0.538

1.00 (ref) 0.69 (0.51
0.92) 0.59 (0.38
0.92)

0.011 0.019

1.00 (ref) 1.20 (0.92
1.56) 1.18 (0.78
1.77)

0.171 0.434

1.00 (ref) 2.37 (1.70
3.31) 5.08 (3.55
7.27)

B0.001 B0.001

1.00 (ref) 3.01 (2.25
4.03) 3.39 (2.47
4.65)

B0.001 B0.001

1.00 (ref) 2.54 (1.05
6.14) 5.06 (2.12
12.06)

0.038 B0.001

1.00 (ref) 1.04 (0.63
1.72) 1.55 (0.95
2.53)

0.869 0.081

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Table IV. Adjusted odds ratio for meeting PA recommendations among Portuguese adults Meeting PA recommendations Men

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Explanatory variables Age groups 31
40 41
50 51
60 SES Lower Middle High Education level Lower Middle High BMI (kg/m2) B 25 25
29.9 ] 30 Perception of lifestyle Sedentary/ less active Sufficiently active Active/very active Self-rated health Poor Fair Excellent

Adjusted OR (95% CI)

Women

p

Adjusted OR (95% CI)

p

1.00 (ref) 1.32 (0.93
1.88) 1.55 (0.98
2.46)

0.117 0.061

1.00 (ref) 0.97 (0.73
1.29) 1.39 (0.89
2.18)

0.843 0.148

1.00 (ref) 1.34 (0.91
1.97) 1.86 (1.22
2.81)

0.141 0.004

1.00 (ref) 1.50 (1.07
2.11) 1.07 (0.73
1.58)

0.018 0.739

1.00 (ref) 1.30 (0.89
1.90) 0.89 (0.59
1.36)

0.172 0.600

1.00 (ref) 1.39 (0.99
1.96) 1.38 (0.97
1.98)

0.055 0.076

1.00 (ref) 0.66 (0.48
0.90) 0.78 (0.49
1.24)

0.009 0.290

1.00 (ref) 1.42 (1.07
1.89) 1.55 (1.00
2.42)

0.016 0.053

1.00 (ref) 2.16 (1.53
3.05) 4.61 (3.13
6.81)

B0.001 B0.001

1.00 (ref) 3.32 (2.38
4.41) 3.68 (2.63
5.15)

B0.001 B0.001

1.00 (ref) 2.25 (0.91
5.56) 3.14 (1.28
7.71)

0.081 0.013

1.00 (ref) 0.61 (0.52
1.47) 1.06 (0.62
1.81)

0.611 0.828

since LTPA is not common in developing countries (Ku et al., 2006). Considering that most people do not meet the PA recommended levels in LT, the promoting strategies to improve PA among adults should also focus on PA at workplace and active commuting. From the preliminary analysis of data, men are more active than women. However, when total LTPA was analysed according to the CDC/ACSM guidelines criterion gender differences were not found, unlike other studies that showed that women were less likely to engage in PA that meets the guidelines (Belanger et al., 2011; Bernstein, Costanza, & Morabia, 2001; Burton & Turrell, 2000; Shibata et al., 2009). This result is interesting and suggests that the difference between men and women may be related to PA at workplace and commuting. In contrast to several studies, which found that participation in PA decreases with age (Belanger et al., 2011; Bernstein et al., 2001; Dias-da-Costa et al., 2005; Martinez-Gonzalez et al., 2001; Santos, Aires, Santos, Ribeiro, & Mota, 2008), we found no significant association between age and PA recommended level participation in LT. Aware that certain age groups could skew the results, we removed from the sample those who were over 60 years of age, who could be retired. This was necessary because there have been mixed reports about the relationship

between age and LTPA with some studies finding an increase of LTPA after this age (Chen et al., 2011; Varo et al., 2003), whereas others show a decrease (Lagerros, Bellocco, Adami, & Nyren, 2009; Martin, Morrow, Jackson, & Dunn, 2000; USDHHS, 1996). The absence of the association between age and meeting PA recommendation level during LT could reflect the type of work the subjects had and the context in which they lived. It is known that people who live in urban areas face considerable economic pressure, and have time constraints, regardless of age. Data from this study indicate that, among men, low SES respondents were less likely to meet the PA recommendation in LT. This finding is consistent with a number of studies that indicated that highest prevalence of physical inactivity is among lower SES adults (Bernstein et al., 2001; Dias-da-Costa et al., 2005; Wilson, Kirtland, Ainsworth, & Addy, 2004). However, this is contrary to findings among young Portuguese individuals, where the influence of SES on adolescents’ self-reported PA was not found (Mota & Silva, 1999). Our findings support the hypothesis that higher SES adults are more likely to follow preventive programmes and health-promoting behaviour, whether due to greater motivation or access to resources. On the other hand, women with middle

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SES were more likely to meet recommendation for PA in LT than those from low and high SES. This confirms that people with low SES have limited ability to control their PA in the face of inaccessible environments (Estabrooks, Lee, & Gyurcsik, 2003; Wilson et al., 2004). With regard to women with high SES, one can only speculate that they generally have high control, high daily demands and long work hours, which might, therefore, reduce their time available for LTPA. The educational level was not associated with meeting PA recommendation in LT, with the exception of women. However, even among women, the educational level was not significant when incorporated into the multivariate analysis. This result is not consistent with previous investigations which showed that participants who achieved a higher educational level had lower prevalence of a sedentary lifestyle (Dias-da-Costa et al., 2005; Martinez-Gonzalez et al., 2001; Varo et al., 2003). Nevertheless, results from Japan are similar to ours for men and women (Shibata et al., 2009), despite the variance in cultural practices. Among women, the results showed a trend: the most educated were more likely to attain to PA recommendation in LT, but the same is not seen among men. This means that this factor has a different effect on men and women, and attention should be paid in developing programmes to intervene with the aim of increasing LTPA participation. This confirms Varo et al. (2003), which stated that the correlation between PA and educational level is not entirely understood. Thus, future studies may be designed to improve the understanding of the relationship between LTPA and educational level. With regard to BMI, the higher prevalence of subjects with a BMI ]25 kg/m2 found in men compared with women is consistent with other studies (Martinez, Kearney, Kafatos, Paquet, & Martinez-Gonzalez, 1999; Martinez-Gonzalez et al., 2001; Santos et al., 2008). In addition, the association between BMI and PA recommended level in LT is different between the two genders. Among men, an inverse association was seen. Those with a BMI ]25 kg/m2 had the lowest proportion of reaching the PA recommendation during LT and were less likely to meet the recommendation for PA in LT, confirming previously reported association (Martinez-Gonzalez et al., 2001; Varo et al., 2003), whereas among women, the present survey shows a positive association between BMI and PA recommended level, not in agreement with other investigations (Dowda et al., 2003; Lagerros et al., 2009; Varo et al., 2003; Wilson et al., 2004). After adjusting all variables the effect reached significance for those with a BMI 25
29.9 kg/m2. Based on these results, for men, being overweight and being obese seem to be a barrier to the practice of PA

recommended level in TL. Nonetheless, for women this seems to serve as a stimulus, perhaps because they give more importance to body image and they know that practicing PA is associated with losing weight. The relationship between PA and perception of lifestyle has rarely been explored in literature. In this study both men and women who perceived to be physically active were more likely to meet the recommendations for PA in LT. This means that those who regularly engage in PA have the perception that they are active, which is accurate, once they practice VPA at least three times a week or MPA five times a week. The perception of an active lifestyle is important, because it means that they did not perceive barriers to practice LTPA. Rating self-perceived health highly was an important correlate of meeting PA in LT for men, but not for women, supporting previous findings related to men (Bergman et al., 2008; Kruger et al., 2007). The association between recommended PA level in LT and self-rated health remained significant after adjustment for several confounders, which is in accordance with a previous study (Sodergren et al., 2008). Self-rated health seems to be an important correlate for men to achieve the recommended PA levels in LT but the same was not true for women. A possible explanation for the difference in selfassessment of health between men and women is that it is understood differently as it is a subjective measure. It means that women’s LTPA participation is independent of their self-rated health, unlike men. These different results for men and women suggest that strategies, unique to each gender, should be undertaken to promote LTPA. The current investigation had a number of limitations. The analysis was cross-sectional, thereby we cannot infer causal relationship between LTPA and the correlates. Since we used a sample that is not representative of adults living in Lisbon and had not been selected at random, this is another limitation of the study and the results have to be interpreted carefully. PA was self-reported rather than objectively measured, which could be subject to bias. In addition, the study focused only in LTPA and did not include activity at work, housework or commuting. Individuals who are inactive during LT may be more active in other contexts. Finally, we conducted this study in an urban area, and thus we cannot extrapolate the results to other populations, particularly adults from rural areas. Conclusion In summary, significant correlates of attaining the recommended level of PA were observed in several domains. For men, the perception of an active

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lifestyle, an excellent perception of health and having a high SES were associated with meeting the recommended level of PA in LT. For women, perception of an active lifestyle, having a middle SES and being overweight were related to achieving the PA recommended level during LT. The findings of this study give additional evidence to the literature on the multivariate factors associated with PA behaviour. They also provide important information for the development of interventions to increase the number of Portuguese adults who meet PA recommended level, taking into account the differences between genders. Future studies should add more correlates, observed in literature and potential, of PA, and, concomitantly, analyse specific domains of PA, such as: commuting, activity at work and housework. References Ainsworth, B. E., Haskell, W. L., Herrmann, S. D., Meckes, N., Bassett, D. R., Jr, Tudor-Locke, C., et al. (2011). 2011 Compendium of physical activities: A second update of codes and MET values. Medicine & Science in Sports & Exercise, 43, 1575
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