Ciência & Saúde Coletiva

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FREE THEME ARTICLE • Ciênc. saúde coletiva 30 (07) • July 2025 • https://doi.org/10.1590/1413-81232025307.05232023EN linkcopy

Counseling strategies on the physical activity practice received by adults in Primary Health Care

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study analyzed the association between sociodemographic characteristics, health conditions, stages of change behavior, and the different counseling strategies on the physical activity (PA) practice received by users of Primary Health Care (PHC) of the Unified Health System. A cross-sectional study was conducted with a representative sample of 779 adults treated at the 15 Basic Health Units in São José dos Pinhais, Brazil. The variables were measured with valid instruments, and the counseling strategies were evaluated based on the “5 As” method. As main results, the two most frequently reported strategies were “receiving information about PA benefits” (91%) and “assessing the PA level” (84%). Age group, hypertension, number of comorbidities, and the medication consumed were consistently associated with at least 50% of the counseling strategies received (p < 0.05). No associations were observed between the variables analyzed and the two most frequently reported strategies. It is concluded that the counseling strategies received vary according to the some analyzed variables.

Key words:
Health strategies; Motor activity; Behavior control; Biobehavioral sciences; Unified Health System

Variables	n	%
Socio-demographic
Sex
Female	544	69.8
Male	235	30.2
Age group (years)
18-39	346	45.2
40-59	283	36.9
≥ 60	137	17.9
Missing	33
Marital status
Without a partner	280	36.0
With a partner	497	64.0
Missing	2
Skin color
White	566	73.0
Brown	157	20.3
Black	49	6.3
Yellow	3	0.4
Missing	4
Education level Incomplete elementary schooling	247	31.7
Complete elementary schooling	139	17.8
Complete high school or higher education	393	50.5
Lower classes (C+D+E)	555	71.2
Upper classes (A+B)	224	28.8
Health conditions
Body Mass Index
Underweight (< 24.9 kg/m2)	248	32.2
Normal weight (25.0-29.9 kg/m2)	291	37.4
Overweight (≥ 30.0 kg/m2)	230	29.9
Missing	30
Hypertension
No	499	64.1
Yes	280	35.9
Diabetes
No	657	84.3
Yes	122	15.7
Dyslipidemia
No	655	84.1
Yes	124	15.9
Coronary artery disease
No	728	93.5
Yes	51	6.5
Number of comorbidities*
0	427	54.8
1	204	26.2
≥ 2	148	19.0
Number of medications
0	387	49.7
1-3	277	35.6
≥ 4	115	14.8
Access to healthcare services
Number of visits to Basic Healthcare Unit (BHU) within the last 12 months
1-3	394	50.6
4-7	203	26.1
≥ 8	182	23.4
Stages of change behavior (SCB) for leisure-time physical activity (LTPA)
Pre-contemplation	138	17.7
Contemplation	165	21.2
Preparation	172	22.1
Action	37	4.7
Maintenance	267	34.3

	n	%
Did you receive counseling on PA? (n = 779)
No	444	57.0
Yes	335	43.0
Counseling strategies taken by health professionals (n = 335)* Did the health professional who provided the counseling…
Commented on the benefits of regular PA for health?	304	90.7
Asked about your PA level?	282	84.2
Commented about PA recommendations for health?	206	61.5
Advised PA based on your characteristics?	194	57.9
Identified your PA barriers?	93	27.8
Offered solutions to address those barriers?	49	14.6
Used any strategy to identify if you are regularly engaging in PA following the counseling?	9	2.7
Used any strategy to identify if you started PA following the counseling?	8	2.4
Health professional who provided the counseling (n = 335)*
Physician	326	97.3
Nurse	50	14.9
Nutritionist	37	11.0
Community health works	13	3.9
Physiotherapist	9	2.7
Pharmacist	8	2.4
Psychologist	8	2.4
When counseling was offered (n = 335)
During a medical consultation	331	98.8
During blood pressure measurement	11	3.3
In the waiting room of the Basic Healthcare Unit	6	1.8
In Basic Healthcare Unit groups	5	1.5
During home visits	3	0.9

	Commented on the PA benefits	Asked about your PA level	Commented about PA recommendations	Advised PA based on individual characteristics	Identified PA barriers	Offered solutions to address those barriers	Used any strategies to identify PA practice	Used any strategies to identify PA start
	%	%	%	%	%	%	%	%
Socio-demographic
Sex - sig.	0.423^h	0.139^h	0.122^h	0.033^h	0.163^h	0.428^h	0.519^f	0.697^f
Female	91.6	86.1	64.1	61.6	30.0	15.6	2.5	2.1
Male	88.8	79.6	55.1	49.0	22.4	12.2	3.1	3.1
Age group (years)- sig.	0.984^t	0.773^t	0.016^t	0.049^t	0.001^t	0.003^t	0.061^f	0.072^f
18-39	90.4	84.3	51.3	49.6	16.5	7.8	0.0	0.0
40-59	91.0	83.3	66.7	61.1	31.3	15.3	4.2	2.8
≥ 60	90.4	86.3	67.1	63.0	37.0	23.3	2.7	4.1
Marital status - sig.	0.806^h	0.530^h	0.154^h	0.119^h	0.031^h	0.702^h	0.276^f	0.100^f
Without a partner	90.1	82.2	67.3	64.4	35.6	15.8	4.0	2.0
With a partner	90.9	84.9	59.1	55.2	24.1	14.2	2.2	2.6
Skin color - sig.	0.126^h	0.725^h	0.195^h	0.357^h	0.314^h	0.038^h	0.240^f	0.584^f
White (white. yellow)	89.5	84.9	63.9	59.7	29.4	17.2	2.1	2.5
Non white (black. brown)	94.8	83.3	56.3	54.2	24.0	8.3	4.2	2.1
Education level - sig.	0.876^t	0.721^t	0.120^t	0.545^t	0.216^t	0.069^t	0.662^f	0.444^f
Incomplete elementary schooling	90.8	82.4	65.6	58.8	29.8	17.6	3.8	3.1
Complete elementary schooling	88.9	87.0	64.8	63.0	35.2	20.4	1.9	3.7
Complete high school or higher education	91.3	84.7	56.7	55.3	23.3	10.0	2.0	1.3
Economic class - sig.	0.806^h	0.590^h	0.606^h	0.862^h	0.729^h	0.914^h	0.461^f	0.100^f
Lower classes (C+D+E)	91.0	84.8	60.7	58.2	28.3	14.8	2.5	2.5
Upper classes (A+B)	90.1	82.4	63.7	57.1	26.4	14.3	3.3	2.2
Health conditions
Body Mass Index - sig.	0.971^t	0.879^t	0.077^t	0.001^t	0.080^t	0.115^t	0.252^f	0.280^f
Underweight (< 24.9 kg/m2)	92.6	82.7	53.1	43.2	22.2	12.3	0.0	0.0
Normal weight (25.0-29.9 kg/m2)	87.7	85.1	61.4	56.1	23.7	10.5	2.6	3.5
Overweight (≥ 30.0 kg/m2)	91.9	83.8	65.4	66.9	32.4	19.1	3.7	2.9
Hypertension - sig.	0.464^h	0.538^h	0.009^h	0.076^h	0.004^h	0.006^h	0.085^f	0.002^f
No	91.8	83.1	55.2	53.6	21.3	9.8	1.1	0.0
Yes	89.5	85.5	69.1	63.2	35.5	20.4	4.6	5.3
Diabetes - sig.	0.493^h	0.445^h	0.055^h	0.224^h	0.171^h	0.028^h	0.003^f	0.001^f
No	90.2	83.4	58.9	56.2	26.0	12.5	1.1	0.8
Yes	92.9	87.1	71.4	64.3	34.3	22.9	8.6	8.6
Dyslipidemia - sig.	0.978^h	0.165^h	0.034^h	0.225^h	0.130^h	0.025^h	0.029^f	0.078^f
No	90.8	82.7	58.5	56.2	25.8	12.3	1.5	1.5
Yes	90.7	89.3	72.0	64.0	34.7	22.7	6.7	5.3
Coronary artery disease - sig.	0.377^h	0.826^h	0.206^h	0.040^h	0.003^h	<0.001^h	0.178^f	0.024^f
No	91.2	84.3	60.5	56.2	25.5	12.4	2.3	1.6
Yes	86.2	82.8	72.4	75.9	51.7	37.9	6.9	10.3
Number of comorbidities*- sig.	0.817^t	0.316^t	0.005^t	0.052^t	0.001^t	<0.001^t	0.003^f	<0.001^f
0	90.8	82.4	54.2	51.4	19.7	7.7	0.7	0.0
1	91.4	83.8	61.9	61.9	27.6	12.4	1.0	1.0
≥ 2	89.8	87.5	72.7	63.6	40.9	28.4	8.0	8.0
Number of medications - sig.	0.844^t	0.321^t	0.004^t	<0.001^t	<0.001^t	<0.001^t	0.029^f	0.008^f
0	90.1	82.9	54.1	45.9	19.8	5.4	0.9	0.0
1-3	91.2	83.0	60.4	57.9	25.8	15.7	1.9	1.9
≥ 4	90.8	89.2	76.9	78.5	46.2	27.7	7.7	7.7
SCB for LTPA - sig.	0.625^t	0.760^t	0.551^t	0.392^t	0.020^t	0.429^t	0.093^f	0.002^f
Pre-contemplation and contemplation	91.7	83.5	58.7	56.9	36.7	17.4	0.9	0.0
Preparation	90.8	83.9	63.2	52.9	24.1	12.6	1.1	0.0
Action and maintenance	89.9	84.9	62.6	61.9	23.0	13.7	5.0	5.8
Prevalence	90.7%	84.2%	61.5%	57.9%	27.8%	14.6%	2.7%	2.4%

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ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

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