Chronic noncommunicable diseases multimorbidity and its association with physical activity and television time in a representative Brazilian population

Christofoletti, Marina; Duca, Giovani Firpo Del; Umpierre, Daniel; Malta, Deborah Carvalho

doi:10.1590/0102-311X00016319

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ARTICLE • Cad. Saúde Pública 35 (11) • 2019 • https://doi.org/10.1590/0102-311X00016319 copy

Chronic noncommunicable diseases multimorbidity and its association with physical activity and television time in a representative Brazilian population

Multimorbidade de doenças crônicas não transmissíveis e associação com atividade física e tempo de televisão em uma população brasileira representativa

Multimorbilidad de enfermedades crónicas no transmisibles y su asociación con la actividad física y tiempo frente a la televisión en una población representativa brasileña

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Lifestyle behaviors need to be more explored within the context of chronic noncommunicable disease (NCD) multimorbidity. This study aimed to investigate the association of multimorbidity with physical activity and sedentary behavior in a representative Brazilian population (n = 52,929). A cross-sectional survey (VIGITEL in the Portuguese acronym) was conducted in 2013 in the 27 Brazilian federal units. Multimorbidity is defined as the presence of two or more NCDs, that is, the outcome variable; and physical activity (commuting, domestic chores, leisure, and work domains) and sedentary behavior (television time < 2 hours/day and ≥ 2 hours/day) were the exposure variables. Poisson and multinomial logistic regressions (odds ratio - OR) stratified by age and their respective 95% confidence intervals were used, adopting a significance level of 5%. Among 37,947 adults, the presence of three chronic diseases was less frequent in subjects active in the work domain (OR = 0.60) and more frequent among those with longer daily television time (OR = 1.25). The presence of four diseases was less frequent in subjects active in the commuting (OR = 0.52) and work (OR = 0.42) domains. Among 14,982 older adults, the presence of two, three, and four chronic diseases was consistently more frequent in those with longer daily television time (OR = 1.33; 1.55 and 1.93, respectively). Finally, interactions between total physical activity level and daily television time were statistically significant in the multimorbidity in both age groups. Physical activity and sedentary behavior are associated with multimorbidity and should be considered independent factors for health promotion and for the treatment of patients with multimorbidity.

Keywords:
Chronic Disease; Exercise; Sedentary Behavior

Variable	Adults (n = 37,947)				Older adults (n = 14,982)
Variable	n	% *	95%CI **	Missing (%)	n	% *	95%CI **	Missing (%)
Domestic physical activity				0.3				0.4
No	21,981	59.9	59.0; 60.9		10,205	66.8	65.2; 68.4
Yes	15,903	40.1	39.1; 41.0		4,725	33.2	31.6; 34.8
Commuting physical activity				0.7				1.0
No	26,135	61.9	60.9; 62.9		13,248	86.6	85.3; 87.9
Yes	11,539	38.1	37.1; 39.1		1,588	13.4	12.1; 14.7
Work physical activity				0.0				0.0
No	22,895	56.4	55.4; 57.4		12,781	82.8	81.4; 84.2
Yes	15,038	43.6	42.6; 44.6		2,198	17.2	15.8; 18.6
Leisure-time physical activity				0.0				0.0
No	18,868	53.3	52.3; 54.3		8,141	63.1	61.5; 64.7
Yes	19,079	46.7	45.7; 47.7		6,568	36.9	35.3; 38.5
Total physical activity				0.7				1.0
Inactive	15,347	41.4	40.5; 42.4		7,827	58.5	56.8; 60.1
Insufficiently active	4,922	13.1	12.4; 13.7		2,201	14.0	12.9; 15.2
Active	17,405	45.5	44.6; 46.5		4,808	27.5	26.1; 29.0
Daily television time (hours)				0.0				0.0
Up to 2	19,090	49.1	48.1; 50.1		6,947	44.9	43.1; 46.6
≥ 2	18,857	50.9	49.9; 51.9		8,035	55.1	53.4; 56.9

Variable	2 vs. 0 and 1		3 vs. 0 and 1		4 vs. 0 and 1
Variable	Adjusted OR (95%CI)	p-value	Adjusted OR (95%CI)	p-value	Adjusted OR (95%CI)	p-value
Domestic physical activity		0.187		0.067		0.321
No	1.00		1.00		1.00
Yes	1.10 (0.96; 1.25)		0.80 (0.64; 1.02)		1.32 (0.77; 2.26)
Commuting physical activity		0.801		0.448		0.379
No	1.00		1.00		1.00
Yes	0.98 (0.83; 1.16)		0.89 (0.66; 1.20)		0.76 (0.41; 1.40)
Work physical activity		0.461		< 0.001		0.008
No	1.00		1.00		1.00
Yes	0.95 (0.82; 1.10)		0.60 (0.46; 0.78)		0.48 (0.27; 0.82)
Leisure-time physical activity		0.001		0.162		0.745
No	1.00		1.00		1.00
Yes	1.46 (1.16; 1.84)		1.33 (0.89; 1.98)		0.81 (0.22; 2.94)
Total physical activity		< 0.001		0.048		0.545
Inactive	1.00		1.00		1.00
Insufficiently active	0.66 (0.48; 0.91)		0.79 (0.47; 1.31)		1.15 (0.33; 4.06)
Active	0.54 (0.41; 0.71)		0.66 (0.43; 1.02)		0.79 (0.25; 2.47)
Daily television time (hours)		0.007		< 0.001		0.022
Up to 2	1.00		1.00		1.00
≥ 2	1.20 (1.05; 1.38)		1.50 (1.20; 1.88)		1.97 (1.10; 3.52)

Variable	2 vs. 0 and 1		3 vs. 0 and 1		4 vs. 0 and 1
Variable	Adjusted OR (95%CI)	p-value	Adjusted OR (95%CI)	p-value	Adjusted OR (95%CI)	p-value
Domestic physical activity		0.004		0.334		0.025
No	1.00		1.00		1.00
Yes	0.77 (0.65; 0.92)		0.89 (0.70; 1.13)		0.56 (0.34; 0.93)
Commuting physical activity		0.797		0.101		0.427
No	1.00		1.00		1.00
Yes	0.96 (0.69; 1.33)		0.65 (0.39; 1.09)		1.39 (0.62; 3.14)
Work physical activity		0.548		0.139		0.002
No	1.00		1.00		1.00
Yes	0.92 (0.69; 1.22)		0.72 (0.46; 1.11)		0.26 (0.11; 0.62)
Leisure-time physical activity		0.889		0.541		0.359
No	1.00		1.00		1.00
Yes	1.02 (0.74; 1.42)		0.86 (0.54; 1.39)		0.53 (0.14; 2.04)
Total physical activity		0.129		0.424		0.878
Inactive	1.00		1.00		1.00
Insufficiently active	0.72 (0.39; 1.31)		0.91 (0.47; 1.78)		1.03 (0.23; 4.60)
Active	0.67 (0.39; 1.15)		0.77 (0.42; 1.41)		1.11 (0.18; 6.79)
Daily television time (hours)		0.004		< 0.001		0.068
Up to 2	1.00		1.00		1.00
≥ 2	1.29 (1.09; 1.53)		1.54 (1.25; 2.01)		1.54 (0.97; 2.45)

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[1] Correspondence M. Cristofoletti Universidade Federal de Santa Catarina. Campus Reitor João David Ferreira Lima s/n, Florianópolis, SC 88040-900, Brasil. marinachriss@outlook.com