Promoting an active and healthy lifestyle among users of Primary Health Care in Brazil: a study of the VAMOS Program based on the RE-AIM tool

ABSTRACT

Objective:  To evaluate the adoption, reach, and effectiveness of the Active Life Improving Health Program (Programa Vida Ativa Melhorando a Saúde - VAMOS, version 2.0) implemented in Primary Health Care across different regions of Brazil.

Methods:  This community-based intervention con-sisted of 12 sessions conducted by health professionals, with assessments performed at baseline and post-intervention.

Results:  The adoption rate among professionals was 72.7% (n = 8). The reach of the recruitment strategies was 0.34% (n = 231), the intervention reach was 61.0% (n = 141), and the participant retention rate was 75.8% (n = 107). Increases were observed in total physical activity time, reductions in sedentary behavior, improvements in healthy food consumption, decreases in waist circumference, and enhanced perceived quality of life (p < 0.05).

Conclusion:  The VAMOS Program demonstrated high adoption and reach rates, as well as effectiveness in promoting positive changes in physical activity, healthy eating, body measurements, and perceived quality of life, highlighting its potential as a health promotion strategy within Primary Health Care.

Keywords:
Public health; Health promotion; Lifestyle; Behavior.

RESUMO

Objetivo:  Foi avaliar a adoção, o alcance e a efetividade do Programa Vida Ativa Melhorando a Saúde (VAMOS, versão 2.0) implantado na Atenção Primária à Saúde de diferentes regiões do Brasil.

Métodos:  Trata-se de uma intervenção comunitária composta por 12 encontros conduzidos por profissionais de saúde, com avaliações realizadas no baseline e pós-intervenção. Resultado: A taxa de adoção pelos profissionais foi de 72,7% (n = 8). O alcance das estratégias de recrutamento foi de 0,34% (n = 231), o alcance da intervenção foi de 61% (n = 141) e a taxa de retenção dos participantes foi de 75,8% (n = 107). Observou-se aumento no tempo dedicado à atividade física total, redução do comportamento sedentário, melhora no consumo de alimentos saudáveis, redução da circunferência da cintura e aumento da percepção positiva de qualidade de vida (p < 0,05).

Conclusão:  O Programa VAMOS apresentou taxas elevadas de adoção e alcance, além de efetividade na promoção de mu-danças positivas em atividade física, alimentação saudável, medidas corporais e percepção positiva da qualidade de vida, evidenciando seu potencial como estratégia de promoção da saúde na Atenção Primária.

Palavras-chave:
Saúde pública; Promoção da saúde; Estilo de vida; Comportamento.

Introduction

No communicable diseases and conditions affect approximately 70% of the global population¹. Among modifiable behavioral risk factors, physical inactivity and unhealthy diet stand out as the main causes associated with no communicable diseases and conditions². Consequently, public policies have directed efforts to-ward promoting lifestyle changes, with an emphasis on encouraging physical activity and the consumption of healthy foods³. However, in Brazil, 37% of the adult population does not meet adequate levels of physical activity, and 78.6% do not consume the minimum amount of fruits and vegetables recommended by the World Health Organization⁴.

Interventions within the scope of Primary Health Care (PHC) have been prioritized in health promo-tion agendas. In this context, several goals have been established, including the development of communi-ty-based programs aimed at promoting physical activ-ity and healthy eating³-⁵. The literature indicates that approximately 54% of these programs address both topics⁶; however, there are difficulties in quantifying the public health impact of such interventions. This limitation is mainly due to insufficient information regarding the evaluation of essential factors, such as adoption by health professionals, reach among the tar-get population, and program effectiveness⁷.

The Active Life Improving Health Program (Programa Vida Ativa Melhorando a Saúde - VAMOS, ver-sion 2.0) is a community-based intervention designed to promote an active and healthy lifestyle. Its approach is grounded in education as a central element for be-havior change, with an emphasis on physical activity practices and healthy eating⁸. Its effectiveness has been demonstrated in different contexts⁹-¹¹. However, orga-nizational adoption, recruitment of the target popula-tion, and intervention reach within the PHC setting remain underexplored, as these factors directly influ-ence program effectiveness.

Therefore, the objective of this study was to evaluate the RE-AIM framework dimensions¹²-adoption, reach, and effectiveness-considering the implemen-tation of the VAMOS Program (version 2.0) in PHC across different regions of Brazil.

Methods

This community-based intervention study was conducted between 2017 and 2019 in Basic Health Units (BHU) from different regions of Brazil. The project was approved by the Ethics Committee for Research with Human Beings (decision no. 1.394.492, protocol no. 475075/2012-9), State Funding Agency of Santa Catarina.

The intervention protocol-the VAMOS Program (version 2.0)-was designed for adults and older adults, with no exclusion criteria applied by the facilitators or the research team responsible for conducting the study. The intervention consisted of 12 face-to-face sessions held weekly or biweekly over a period of three to five months, with a 12-month post-intervention mainte-nance follow-up⁸. The program was based on a health education methodology and was delivered by a health professional (facilitator) previously trained through the Online Training for VAMOS Program Facilitators¹³.

Facilitators who agreed to implement the program in their workplace received the educational materials (12 booklets addressing physical activity and healthy eating) and dissemination materials (posters, flyers, and business cards) free of charge to invite the commu-nity. To implement the VAMOS Program, invitations were sent to 44 health professionals certified through the online training who were working in PHC in dif-ferent regions of the country. These professionals were trained during the online course and, after evaluation and approval, were certified as VAMOS Program facil-itators¹³. After the professional accepted the invitation, the dissemination materials were sent. In all locations, the same dissemination period (15-30 days) and strat-egies were used: posting posters in BHU and commu-nity settings; verbal invitations to users by health team professionals; distribution of business cards during consultations; and distribution of flyers by community health workers in community centers, churches, and during home visits.

Intervention monitoring was conducted remotely by the VAMOS research team in direct contact with the facilitators. Communication between researchers and facilitators occurred via telephone and email. For data collection regarding participant characteristics at baseline and post-intervention, facilitators received an instructional video on how to complete the online forms (Google Forms®). All facilitators and study par-ticipants signed an informed consent form after read-ing the document.

To estimate public health impact, the VAMOS Program uses the RE-AIM framework, which evaluates interventions across five dimensions: adoption, reach, effectiveness, implementation, and maintenance⁷. This study analyzed adoption, reach, and effectiveness.

Adoption refers to an organizational-level mea-sure of participation, considering the absolute number, proportion, and representativeness of settings and/or professionals willing to implement an intervention compared with those eligible. The adoption rate among professionals was calculated by dividing the number of professionals who delivered the intervention by the number of eligible professionals, multiplied by 100.

To assess program reach, three distinct rates were calculated. Considering the study participants, a re-cruitment reach rate was calculated by dividing the number of users who expressed interest in participating in the intervention by the number of potentially eligi-ble users (those exposed to dissemination strategies), multiplied by 100.

Intervention reach, in turn, is an individual-level measure of participation that considers the absolute number, proportion, and representativeness of individ-uals who agreed to participate compared with those eligible. The reach rate was calculated by dividing the number of users who initiated the intervention by the number of eligible users, multiplied by 100. In addi-tion, the participant retention rate was calculated by dividing the number of users who completed the inter-vention by the number of users who initiated it, mul-tiplied by 100.

Effectiveness refers to an individual-level measure assessing the impact of the intervention on the primary outcomes analyzed. In this study, variables were exam-ined based on assessments conducted at baseline and post-intervention. Participants were evaluated using a questionnaire¹⁴ specifically developed to assess the primary markers (physical activity level and dietary behavior) and secondary markers (waist circumference and perceived quality of life) of the VAMOS Program.

Physical activity level was measured using the Inter-national Physical Activity Questionnaire (IPAQ), short version¹⁵, which estimates time spent (minutes/week) in sedentary behavior and in total physical activity (sum of moderateand vigorous-intensity activities).

Dietary behavior was assessed using 12 questions extracted from the Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Survey⁴. For analysis, an overall healthy eating score was gen-erated by summing food groups, ranging from zero to five points, with higher scores indicating healthier dietary behaviors. Responses considered the frequency of consumption of specific foods, categorized as “nev-er,” “almost never,” “1-2 days per week,” “3-4 days per week,” “5-6 days per week,” and “every day” (including Saturday and Sunday).

Waist circumference was measured using a non-elastic measuring tape with 0.1 cm precision, po-sitioned midway between the lowest rib and the iliac crest, following the protocol of the International Soci-ety for the Advancement of Kinanthropometry¹⁶.

Perceived quality of life was assessed using the ques-tion “Considering the past two weeks, how would you rate your quality of life?” extracted from the WHO-QOL-BREF questionnaire¹⁷. Response options were “very poor,” “poor,” “neither poor nor good,” “good,” and “very good.” Based on this, the percentage of par-ticipants with a negative quality of life (very poor or poor) or a positive quality of life (neither poor nor good, good, and very good) was calculated.

In the descriptive analysis, continuous variables were expressed as mean and standard deviation, while categorical variables were presented as absolute and relative frequencies. For inferential analysis, data dis-tribution was assessed using the Kolmogorov-Smirnov test. Comparisons between baseline and post-inter-vention data were performed using the paired Stu-dent’s t test and the Wilcoxon test. A significance level of 5% was adopted for all analyses. Data were analyzed using the Statistical Package for the Social Sciences (SPSS®), version 22.0, and the quality of life variable was analyzed using MedCalc®, online version. All analyses were conducted per protocol, considering only participants assessed at both study time points (base-line and post-intervention).

Results

Adoption

A total of 44 health professionals, certified through the online training, were invited to implement the VA-MOS program. Of these, 23 did not respond to emails, and 10 declined for various reasons: maternity leave (n = 1), vacations or departure from service (n = 7), or inability due to other scheduled activities at the BHU (n = 2). In total, 11 professionals expressed interest in implementing the intervention at their linked BHU unit. After the dissemination of materials was sent, eight health professionals effectively implemented the program, corresponding to an adoption rate of 72.7%.

The VAMOS program was implemented in munic-ipalities from the South (n = 4), Southeast (n = 2), and Northeast (n = 2) regions of Brazil. Among the eight municipalities, three were classified as small (2,617 to 3,527 inhabitants), two as medium-sized (12,609 to 62,263 inhabitants), and three as large (138,572 to 157,743 inhabitants). The health professionals were from the fields of Physical Education (n = 4), Psychol-ogy (n = 2), Nutrition (n = 1), and Physiotherapy (n = 1), with an average of 3.5 years (SD = 2.0) of experi-ence in PHC. The majority were women (62.5%; n = 5), married (62.5%; n = 5), with an average age of 36.5 years (SD = 5.5) and an income between 5 and 10 minimum wages (62.5%; n = 5).

Reach

The target population of the study consisted of users from eight BHU (n = 66,706). The reach rate of re-cruitment strategies was 0.34% (n = 231). Of these, 141 initiated the program, resulting in an intervention reach rate of 61%. By the end of the intervention, re-tention was 75.8% (n = 107) (Figure 1).

Figure 1
Recruitment, reach, and retention rates of participants in the VAMOS Program (version 2.0) in Primary Health Care, Brazil, 2019.

Among the 107 program participants, the majority were women (93.4%; n = 100), aged between 18 and 40 years (42.9%; n = 46), of mixed race (48.6%; n = 52), married (54.2%; n = 58), with completed high school education (31.7%; n = 34), low income (1 to 2 mini-mum wages) (34.5%; n = 37), and economically active (35.1%; n = 38).

Effectiveness

Table 1 presents the data from baseline and post-in-tervention assessments at each BHU, considering the markers of the VAMOS Program. In general, a sta-tistically significant increase was observed in total physical activity time, reduction in sedentary behavior, improvement in healthy food consumption, reduction in waist circumference, and improvement in perceived quality of life (p < 0.05).

Table 1
Effectiveness of the VAMOS Program (version 2.0) in Primary Health Care (n = 103), Brazil, 2019.

Municipality	Total physical activity (minutes/week) Average (standard deviation)			Sedentary behavior (minutes/week) Average (standard deviation)			Diet Average (standard deviation)			Waist circumference (centimeters) Average (standard deviation)
	Pre	Post	P	Pre	Post	P	Pre	Post	P	Pre	Post	P
Basic Health Unit 1 (n = 14)	832.14 (933.1)	743.58 (856.3)	0.99	432.14 (178.0)	469.29 (186.6)	0.40	32.08 (5.6)	34.08 (5.1)	0.001*	85.64 (17.4)	80.71 (17.6)	0.001*
Basic Health Unit 2 (n = 15)	698.48 (538.9)	732.67 (322.5)	0.60	430.00 (211.6)	362.00 (112.5)	0.08	33.40 (6.4)	37.47 (4.1)	0.001*	84.30 (9.5)	81.80 (8.4)	0.001*
Basic Health Unit 3 (n = 13)	1228.39 (1306.5)	2771.08 (2379.5)	0.001*	492.30 (253.3)	406.15 (193.5)	0.001*	33.08 (6.5)	34.53 (4.4)	0.20	91.00 (14.2)	87.80 (12.9)	0.001*
Basic Health Unit 4 (n = 6)	1056.66 (955.0)	1731.67 (2013.6)	0.99	424.14 (169.6)	390.09 (168.6)	0.10	30.67 (3.6)	35.17 (3.3)	0.09	84.00 (11.0)	82.67 (10.1)	0.08
Basic Health Unit 5 (n = 25)	1755.80 (1753.8)	1558.20 (1487.8)	0.20	588.80 (250.3)	514.80 (159.6)	0.001*	28.37 (8.3)	31.44 (6.6)	0.001*	89.82 (11.3)	87.28 (12.3)	0.90
Basic Health Unit 6 (n = 13)	821.92 (1183.1)	988.07 (1107.0)	0.40	685.39 (434.7)	823.84 (402.2)	0.50	29.39 (4.0)	32.53 (4.1)	0.001*	90.82 (9.5)	92.58 (12.0)	0.30
Basic Health Unit 7 (n = 8)	1007.12 (875.3)	1178.75 (749.2)	0.60	356.25 (147.3)	375.00 (131.2)	0.60	35.25 (3.1)	35.25 (3.4)	0.999	98.88 (15.5)	99.75 (16.3)	0.60
Basic Health Unit 8 (n = 9)	760.55 (695.4)	1125.55 (675.8)	0.99	315.00 (144.2)	383.33 (186.6)	0.40	36.67 (3.7)	36.22 (4.4)	0.70	105.44 (12.9)	105.31 (12.8)	0.30
Overall (n = 103)	1105.91 (1239.8)	1351.23 (1455.5)	0.001*	492.84 (268.0)	482.05 (247.4)	0.30	31.76 (6.5)	34.12 (5.3)	0.001*	90.43 (13.7)	88.62 (14.6)	0.001*

• Legend: p = probability value;
• ^*
  p < 0.01

Regarding physical activity, participants from sev-en BHU increased their total physical activity time. The weekly average increased from 1,105.9 minutes/ week (SD = 1,239.8) at baseline to 1,351.2 minutes/ week (SD = 1,455.5) post-intervention, represent-ing a 22.3% increase. In four BHU (BHU 1, BHU 6, BHU 7, and BHU 8), 50% of participants increased the time spent in sedentary behavior, although without statistical significance. On average, sedentary behavior decreased from 492.8 minutes/week (SD = 268.0) to 482.0 minutes/week (SD = 247.4).

Regarding dietary behavior, a statistically significant improvement in food choices was observed in at least 75% of the participants across the BHU. The healthy eating score increased from 31.7 points (SD = 6.5) at baseline to 34.1 points (SD = 5.3) post-intervention.

Another marker used in the program is waist cir-cumference measurement. In 75% of the BHU, a re-duction was observed post-intervention. The average decreased from 90.4 cm at baseline to 88.6 cm post-in-tervention, representing a 2% reduction, albeit modest, but a positive effect.

Finally, in the perception of quality of life, an im-provement was observed in 87.5% of the BHU. The percentage of participants reporting positive quality of life increased from 61.2% (n = 63) at baseline to 80.6% (n = 83) post-intervention, corresponding to a 19.4% increase in VAMOS participants.

Discussion

The implementation of the VAMOS Program showed positive results across the three evaluated dimensions. Regarding adoption, eight of the 44 invited health professionals effectively implemented the intervention, resulting in an adoption rate of 72.7%, spread across different regions of the country with diverse educa-tional backgrounds. Concerning reach, the program engaged users from eight BHU, reaching 231 indi-viduals, of whom 141 started, and 107 completed the intervention (75.8% retention), with a predominance of women, mixed-race individuals, married, low-in-come, and with medium education. In the effectiveness dimension, significant improvements were observed, including increased physical activity time, reduced sedentary behavior, improved food choices, reduced waist circumference, and improved positive quality of life perception, indicating a substantial impact on both objective and subjective health markers.

Adoption

Information on adoption rates and the characteristics of organizations agreeing to implement an intervention are crucial, as they directly influence the imple-mentation process, especially in varying contexts⁷. The literature does not provide a consensus on cutoff points for good adoption rates, as this dimension depends on local realities. Community intervention studies using the RE-AIM model report organizational adoption rates ranging from 28%¹⁸ to 100%¹⁹. Additionally, the quantity of items reported on this dimension can dif-fer significantly. A systematic review found that only 25% of studies reported adoption data, with the most frequently reported items being the target population description (57%), inclusion/exclusion criteria (17%), intervention setting description (33%), participation rates (15%), and methods used (9%)²⁰. Another sys-tematic review of behavior changes programs in Brazil found that only 17% of studies reported adoption ele-ments, 37% described the team, and 23% detailed the intervention setting⁶.

In this study, no health professionals from the North and Central-West regions expressed interest in imple-menting the VAMOS program. In the North region, no facilitators were certified, while in the Central-West region, neither of the two certified professionals adopt-ed the program. The main reasons reported were a lack of availability to implement the intervention and a lack of support from management/health teams.

The development of actions within PHC depends on the engagement of management, health teams, and available infrastructure. The program’s logical frame-work anticipates its insertion in different contexts⁸ and provides free online training to enable health profes-sionals from any BHU in the country to implement the program. This training serves as a facilitation tool, promoting health promotion activities across various regions and contexts, while also supporting the contin-uous education of health professionals and strength-ening the implementation of public health promotion strategies²¹.

Monitoring data from the Ministry of Health indicate that most PHC actions are concentrated in the Northeast (35.8%), Southeast (31.2%), and South (19%) regions, while the North and Central-West re-gions have the lowest percentages, between 6 and 8%²². Thus, specific strategies involving health managers and professionals in these regions are necessary to expand the implementation of innovative health promotion actions.

Therefore, organizational adoption is a central di-mension for enhancing community interventions, increasing population reach, and expanding the greater impact on public health⁷.

Reach

Understanding the reach of a program is essential for improving an intervention to maximize the number of people served⁷. A systematic review of interna-tional studies revealed that 89% of them presented data on this dimension²³. In Latin America, another review identified that approximately 90% of studies reported data on reach²⁰. Nationally, according to the aforementioned review⁷, 61% of the 26 studies eval-uated included information on reach, with the most frequently described items being the target population (96%), identification method (64%), and participation rate (38%).

A study conducted in the South of Brazil, involv-ing 146 municipalities, investigated the reach of phys-ical activity interventions in public health. The results showed that in 56.8% of municipalities, fewer than 100 users were reached by physical activity interventions, 13.7% had 100 to 199 users, 17.8% had 200 to 400 users, and only 6.2% reported over 500 participants. The average reach was 3.8%²⁴. In contrast, this study presented three reach rates, highlighting not only the population that participated in the intervention study but also the reach rates of recruitment strategies used.

Effectiveness

With regard to effectiveness, although individuals may change their physical activity habits by increas-ing daily levels, reducing sedentary behavior remains challenging²³. Overall, studies using similar protocols have reported consistent findings. Even with increases in physical activity level and time, participants in the VAMOS Program tend to primarily increase light-in-tensity activities in their daily routines, with minimal reductions in sedentary behavior⁹,¹¹.

The literature identifies sedentary behavior as a health risk factor regardless of engagement in physical activity. A systematic review demonstrated a strong as-sociation between sitting time and all-cause mortality among adults, even among those who are physically active²⁵.

Regarding dietary behavior, previous studies¹¹,²⁶ us-ing similar protocols-although with different imple-mentation strategies-have observed consistent results among adult and older adult populations. The VAMOS Program is based on the Dietary Guidelines for the Brazilian Population, addressing aspects ranging from food selection to the preparation of healthier meals, encouraging greater consumption of fruits, vegetables, and unprocessed or minimally processed foods while reducing the intake of processed and ultra-processed foods. The findings of the present study corroborate previous evidence⁹,²⁷, showing increased consumption of unprocessed foods and water, along with reduced intake of salt, sugar, and oil.

Public policies and programs aimed at promot-ing healthy eating among the Brazilian population have been implemented nationwide, with more than 70% of actions carried out within the Unified Health System²⁸. In terms of physical activity, a 1.9-fold in-crease in the number of Health Academy (Academia da Saúde) Program facilities was observed between 2015 (856) and 2017 (1,664)²², reinforcing strategies that seek to develop individual competencies, promote collective actions, and create diverse and healthy food environments²⁹.

Waist circumference is directly associated with dietary intake and sedentary behavior and represents a central measure for assessing the risk of cardiovascular diseases and metabolic syndrome³⁰. Within the context of the VAMOS Program, secondary outcomes such as waist circumference are assessed to monitor interven-tion effects and support health professionals in track-ing cardiovascular risk.

Finally, perceived quality of life, although subjective and influenced by several external factors, is used as a parameter to evaluate adverse effects and the overall impact of public health interventions⁷. In a previous study¹¹ applying the same protocol among PHC us-ers in Belo Horizonte, an approximate 20% increase in perceived quality of life was observed.

The VAMOS Program promotes self-confidence and autonomy among its participants, fostering life-style changes and, as a direct consequence, improve-ments in quality of life. This marker represents a rel-evant outcome of the intervention, particularly from a public health perspective, as it provides a critical as-sessment of the program’s impact²⁰.

Although the literature predominantly focuses on program effectiveness when considering the likelihood of successful implementation, it is equally essential to evaluate outcomes related to other dimensions that are fundamental to the sustainability and replication of interventions in different contexts³¹. The RE-AIM framework has demonstrated applicability for evaluating interventions across multiple settings, allowing projection of effects on all stakeholders involved in the program, from facilitators to participants, as well as on the benefits of implemented actions.

Despite its innovative nature-by presenting an adaptable protocol and encompassing populations from different regions of the country-this study has some limitations. These include the absence of quali-tative data collection from managers, facilitators, and program participants; the lack of a control group to compare effectiveness; and the absence of objective measures to assess physical activity. Addressing these limitations could further strengthen the analyses and reinforce the potential of the VAMOS Program ver-sion 2.0 as a promising health promotion strategy within the Brazilian PHC context.

Some gaps remain, such as the non-participation of the North and Central-West regions and the low ad-herence of male participants to the VAMOS Program. Although relevant, these issues were not addressed within the dimensions analyzed in this study.

In conclusion, the program presented high rates of adoption and reach, as well as effectiveness in promot-ing positive changes in physical activity, healthy eat-ing, body measurements, and perceived quality of life. Thus, the VAMOS Program (version 2.0) led to im-provements in the evaluated markers, directly reflect-ing enhanced health conditions among participants and demonstrating its potential for incorporation as a health promotion strategy across different PHC set-tings.

• Funding
  This work was carried out with the support of the Coordination for the Improvement of Higher Education Personnel - Brazil (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES).

Declaration regarding the use of artificial intelligence tools in the article writing process

The authors used ChatGPT artificial intelligence tools to assist in the translation process of the manuscript.

Acknowledgments

The authors would like to thank the Municipal Health Departments of the participating municipalities for their collaboration in implementing the VAMOS Program in the BHU. We also thank the managers, health team professionals, facilitators, and PHC users involved in this study.

Availability of research data and other materials

The contents underlying the research text are contained in the manuscript.

References

• ¹ World Health Organization (WHO). Noncommunicable Diseases Progress Monitor. Geneva: WHO; 2017. Available from: <http://www.who.int/nmh/publications/en/>. [2019 October].
  » http://www.who.int/nmh/publications/en/
• ² Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219-29. doi: https://doi.org/10.1016/S0140-6736(12)61031-9
  » https://doi.org/10.1016/S0140-6736(12)61031-9
• ³ Malta D, Silva M, Albuquerque G, Amorim R, Rodrigues G, Silva T, et al. et al. Política Nacional de Promoção da Saúde: descrição da implementação do eixo atividade física e práticas corporais, 2006 a 2014. Rev Bras Ativ Fís Saúde. 2014;19(3):286-99. doi: https://doi.org/10.12820/rbafs.v.19n3p286
  » https://doi.org/10.12820/rbafs.v.19n3p286
• ⁴ Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde. VIGITEL Brasil 2023: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: Ministério da Saúde; 2023. Available from: <https://bvsms.saude.gov.br/bvs/publicacoes/vigitel_brasil_2023.pdf> [2024 June].
  » https://bvsms.saude.gov.br/bvs/publicacoes/vigitel_brasil_2023.pdf
• ⁵ Becker LA, Gonçalves PB, Reis RS. Programas de promoção da atividade física no Sistema Único de Saúde brasileiro: revisão sistemática. Rev Bras Ativ Fís Saúde. 2016;21(2):110-22. doi: https://doi.org/10.12820/rbafs.v.21n2p110-122
  » https://doi.org/10.12820/rbafs.v.21n2p110-122
• ⁶ Konrad LM, Tomicki C, Silva M. Avaliação de programas de mudança de comportamento usando a ferramenta RE-AIM: um estudo de revisão sistemática. Rev Bras Ativ Fís Saúde. 2017;22(5):439-49. doi: https://doi.org/10.12820/rbafs.v.22n5p439-449
  » https://doi.org/10.12820/rbafs.v.22n5p439-449
• ⁷ Almeida FA, Brito FA, Estabrooks PA. Modelo RE-AIM: tradução e adaptação cultural para o Brasil. Rev Fam Ciclos Vida Saúde Contexto Soc. 2013;1(1):6-16. doi: https://doi.org/10.18554/refacs.v1i1.602
  » https://doi.org/10.18554/refacs.v1i1.602
• ⁸ Benedetti TRB, Manta SW, Gomez LSR, Rech C. Logical model of a behavior change program for community intervention - Active Life Improving Health - VAMOS. Rev Bras Ativ Fís Saúde. 2017;22(3):309-13. doi: https://doi.org/10.12820/rbafs.v.22n3p309-313
  » https://doi.org/10.12820/rbafs.v.22n3p309-313
• ⁹ Gerage AM, Benedetti TRB, Ritti-Dias RM, Santos ACO, Souza BCC, Almeida FA. Effectiveness of a behavior change program on physical activity and eating habits in patients with hypertension: a randomized controlled trial. J Phys Act Health. 2017;14(12):943-52. doi: https://doi.org/10.1123/jpah.2016-0268
  » https://doi.org/10.1123/jpah.2016-0268
• ¹⁰ Konrad LM, Tomicki C, Ribeiro CG, Bezerra JB, Maciel EC, Rech CR, Gondim FJ, Benedetti TRB. Length of stay in a behavior change program in primary health care: “VAMOS” program. Rev Bras Ativ Fís Saúde. 2019;24:e0090. doi: https://doi.org/10.12820/rbafs.24e0090
  » https://doi.org/10.12820/rbafs.24e0090
• ¹¹ Meurer ST, Lopes ACS, Almeida FA, Mendonça RD, Benedetti TRB. Effectiveness of the VAMOS Strategy for Increasing Physical Activity and Healthy Dietary Habits: A Randomized Controlled Community Trial. Health Educ Behav. 2019;46(3):406-16. doi: https://doi.org/10.1177/1090198118820095
  » https://doi.org/10.1177/1090198118820095
• ¹² Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322-7. doi: https://doi.org/10.2105/AJPH.89.9.1322
  » https://doi.org/10.2105/AJPH.89.9.1322
• ¹³ José HPM, Konrad LM, Ribeiro CG, Benedetti TRB. Validação do treinamento on-line para multiplicadores do Programa Vida Ativa Melhorando a Saúde (VAMOS). J Phys Educ. 2019;30:e3040:1-11. doi: https://doi.org/10.4025/jphyseduc.v39i1.3040
  » https://doi.org/10.4025/jphyseduc.v39i1.3040
• ¹⁴ Silva MC, Ribeiro CG, Benedetti TRB. Programa VAMOS: instrumentos para medida de atividade física, alimentação e antropometria. Rev Bras Cineantropom Desempenho Hum. 2020;22:e58256. doi: https://dx.doi.org/10.1590/1980-0037.2020v22e58256
  » https://dx.doi.org/10.1590/1980-0037.2020v22e58256
• ¹⁵ Matsudo S, Araújo T, Matsudo V, Andrade D, Andrade E, Oliveira LC, Braggion G. Questionário Internacional de Atividade Física(IPAQ):estudodevalidadeereprodutibilidade no Brasil. Rev Bras Ativ Fís Saúde. 2001;6(2):5-18. doi: https://doi.org/10.12820/rbafs.v.6n2p5-18
  » https://doi.org/10.12820/rbafs.v.6n2p5-18
• ¹⁶ Stewart A, Marfell-Jones M, Olds T, Ridder H. International Standards for Anthropometric Assessment. 3rd ed. Lower Hutt, New Zealand: ISAK; 2011. Available from: <https://www.isak.global/> [2015 June].
  » https://www.isak.global/
• ¹⁷ Fleck MPA, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, et al. Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida “WHOQOL-bref ”. Rev Saúde Pública. 2000;34(2):178-83. doi: https://doi.org/10.1590/S0034-89102000000200012
  » https://doi.org/10.1590/S0034-89102000000200012
• ¹⁸ Jung ME, Bourne JE, Gainforth HL. Evaluation of a community-based, family-focused healthy weights initiative using the RE-AIM framework. Int J Behav Nutr Phys Act. 2018;15:13. doi: https://doi.org/10.1186/s12966-017-0638-0
  » https://doi.org/10.1186/s12966-017-0638-0
• ¹⁹ Shaw RB, Sweet SN, McBride CB, Adair WK, Martin Ginis KA. Operationalizing the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework to evaluate the collective impact of autonomous community programs that promote health and well-being. BMC Public Health. 2019;19(1):803. doi: https://doi.org/10.1186/s12889-019-7131-4
  » https://doi.org/10.1186/s12889-019-7131-4
• ²⁰ Galaviz KI, Harden SM, Smith E, Blackman KC, Berrey LM, Mama SK, et al. Physical activity promotion in Latin American populations: systematic review on issues of internal and external validity. Int J Behav Nutr Phys Act. 2014;11:77. doi: https://doi.org/10.1186/1479-5868-11-77
  » https://doi.org/10.1186/1479-5868-11-77
• ²¹ Almeida AH, Cordeiro l, Soares CB. Formação de profissionais para o Sistema Único de Saúde: ensino de educação em saúde emancipatória. Rev Saúde Transform Soc. 2018;9(1/2/3). Available from: <https://incubadora.periodicos.ufsc.br/index.php/saudeetransformacao/article/view/4822> [2020 May].
  » https://incubadora.periodicos.ufsc.br/index.php/saudeetransformacao/article/view/4822
• ²² Wolker SM, Sandreschi PF, Tomicki C, Konrad LM, Quadros EN, Ribeiro CG, et al. Monitoramento do programa academia da saúde de 2015 a 2017. Rev Andal Med Deporte. 2020;13(1):16-20. doi: https://doi.org/10.33155/j.ramd.2019.09.003
  » https://doi.org/10.33155/j.ramd.2019.09.003
• ²³ Harden SM, Gaglio B, Shoup JA, Kinney KA, Johnson SB, Brito F, et al. Fidelity to and comparative results across behavioral interventions evaluated through the RE-AIM framework: a systematic review. Syst Rev. 2015;4:155. doi: https://doi.org/10.1186/s13643-015-0141-0
  » https://doi.org/10.1186/s13643-015-0141-0
• ²⁴ Fank F, Petreça DR, Almeida FA, Mazo GZ. Alcance das intervenções em atividade física na saúde pública de Santa Catarina. Rev Bras Ativ Fís Saúde. 2018;23:e0066. doi: https://doi.org/10.12820/rbafs.23e0066
  » https://doi.org/10.12820/rbafs.23e0066
• ²⁵ Rezende LFM, Sá TH, Mielke GI, Viscondi JYK, Rey-López JP, Garcia LMT. Sedentary behavior and health outcomes: an overview of systematic reviews. PLoS One. 2014;9(8):e105620. doi: https://doi.org/10.1371/journal.pone.0105620
  » https://doi.org/10.1371/journal.pone.0105620
• ²⁶ Scherer FC, Gerage AM, Borges LJ, Borges RA, Melo FC, Teixeira DC, et al. Efeito de dois programas de promoção da atividade física em idosos. Rev Bras Ativ Fís Saúde. 2018;23:e0034. doi: https://doi.org/10.12820/rbafs.23e0034
  » https://doi.org/10.12820/rbafs.23e0034
• ²⁷ Gerage AM, Benedetti TRB, Cavalcante BR, Farah BQ, Ritti-Dias RM. Efficacy of a behavior change program on cardiovascular parameters in patients with hypertension: a randomized controlled trial. Einstein (Sao Paulo). 2020;18:eAO5227. doi: https://doi.org/10.31744/einstein_journal/2020AO5227
  » https://doi.org/10.31744/einstein_journal/2020AO5227
• ²⁸ Ramos LR, Malta DC, Gomes GAO, Bracco MM, Florindo AA, Mielke GI, et al. Prevalence of health promotion programs in primary health care units in Brazil. Rev Saúde Pública. 2014;48(5):837-44. doi: https://doi.org/10.1590/S0034-8910.2014048005249
  » https://doi.org/10.1590/S0034-8910.2014048005249
• ²⁹ Costa BVL, Oliveira CDL, Lopes ACS. Ambiente alimentar de frutas e hortaliças no território do Programa Academia da Saúde. Cad Saúde Pública. 2015;31(Suppl 1):59-69. doi: https://doi.org/10.1590/0102-311X00027114
  » https://doi.org/10.1590/0102-311X00027114
• ³⁰ Cembranel F, Hallal ALC, González-Chica DA, d’Orsi E. Relação entre consumo alimentar de vitaminas e minerais, índice de massa corporal e circunferência da cintura: um estudo de base populacional com adultos no Sul do Brasil. Cad Saúde Pública. 2017;33(12):e00136616. doi: https://doi.org/10.1590/0102-311X00136616
  » https://doi.org/10.1590/0102-311X00136616
• ³¹ Forman J, Heisler M, Damschroder LJ, Kaselitz E, Kerr EA. Development and application of the RE-AIM quest mixed methods framework for program evaluation. Prev Med Rep. 2017;6:322-8. doi: https://doi.org/10.1016/j.pmedr.2017.04.002
  » https://doi.org/10.1016/j.pmedr.2017.04.002

Edited by

• Editor in Chief
  Átila Alexandre Trapé University of São Paulo, Ribeirão Preto, São Paulo, Brazil.

• Section editor
  Maria Cecilia Marinho Tenório University of Illinois Urbana-Champaign, Illinois, United States.

Reviewers’ assessment

The reviews of this article were originally conducted in Portuguese. This version has been translated using ChatGPT and subsequently reviewed by the Chief Editors.About the reviewer

Reviewer A

Format

• Does the article comply with the manuscript prepa-ration guidelines for submission to the Revista Bra-sileira de Atividade Física e Saúde?

  Yes

• Regarding formal aspects, is the manuscript well structured, containing the following sections: intro-duction, methods, results, and discussion (with the conclusion as part of the discussion)?

  Yes

• Is the language appropriate, and is the text clear, precise, and objective?

  Yes

• Was any indication of plagiarism observed in the manuscript?

  No

Suggestions/comments:

No comments

Abstract

• Are the abstract (in Portuguese) and the abstract (in English) adequate-containing the study objective, participant information, studied variables, main results, and a conclusion-and do they reflect the content of the manuscript?

  Yes

Suggestions/comments:

No comments

Introduction

• Was the research problem clearly stated and delim-ited?

  Yes

• Is the research problem appropriately contextual-ized in relation to the existing knowledge, moving from the general to the specific?

  Yes

• Are the reasons that justify the study (including the authors’ assumptions about the problem) well es-tablished in the writing?

  Yes

• Are the references used to support the presentation of the research problem current and relevant to the topic?

  Yes

• Was the objective clearly presented?

  Yes

Suggestions/comments:

No comments

Methods

• Are the methodological procedures generally ade-quate for studying the research problem?

  Yes

• Are the methodological procedures adopted for conducting the study sufficiently detailed?

  Yes

• Was the procedure used for selecting or recruiting participants adequate for the research problem and described in a sufficient, clear, and objective man-ner?

  Yes

• Were information about the instruments used for data collection, their psychometric properties (e.g., reproducibility, internal consistency, and validity), and when applicable, the operational definition of variables provided?

  Yes

• Is the data analysis plan adequate and adequately described?

  Yes

• Were inclusion and/or exclusion criteria for sam-ple participants described and appropriate for the study?

  Yes

• Did the authors provide clarification on the ethical procedures adopted in the research?

  Partially

Suggestions/comments:

• I was unsure about the Research Ethics Committee approval. Was it approved or not?

Results

• Is the use of tables and figures appropriate and does it facilitate proper communication of the study results?

  Yes

• Is the number of illustrations in the article in ac-cordance with the journal’s submission guidelines?

  Yes

• Are the number of participants at each stage of the study, as well as the number and reasons for losses and refusals, presented in the manuscript?

  Yes

• Are the characteristics of the participants presented and sufficient?

  Yes

• Are the results presented adequately, highlighting the main findings and avoiding unnecessary repe-tition?

  Yes

Suggestions/comments:

No comments

Discussion

• Are the main findings of the study presented?

  Yes

• Are the study’s limitations and strengths presented and discussed?

  Yes

• Are the results discussed in light of the study lim-itations and the existing knowledge on the topic?

  Yes

• Do the authors discuss the potential contributions of the main findings for scientific development, in-novation, or real-world interventions?

  Yes

Suggestions/comments:

No comments

Conclusion

• Is the study conclusion presented appropriately and coherent with the study objective?

  Yes

• Is the study conclusion original?

  Yes

Suggestions/comments:

No comments

References

• Are the references up-to-date and sufficient?

  Yes

• Are most of them composed of original research articles?

  Yes

• Do the references comply with the journal’s for-matting and quantity guidelines?

  Yes

• Is in-text citation adequate, meaning that statements are supported by references that substantiate them?

  Yes

Suggestions/comments:

No comments

Comments to the author

• The manuscript is well written and clear. I only sug-gest implementing the corrections noted. I identi-fied only two spacing errors between words:

• Page 1, line 11

• Page 7, line 26

• I was unsure about the Research Ethics Committee approval. Was it approved or not?

Final decision

• Accepted for publication in its current form

• peer review recommendation: accept

History

• Reviewed
  25 Apr 2025

Reviewer B

About the reviewer

Reviewer B

Format

• Does the article comply with the manuscript prepa-ration guidelines for submission to the Revista Bra-sileira de Atividade Física e Saúde?

  Yes

• Regarding formal aspects, is the manuscript well structured, containing the sections introduction, methods, results and discussion (with the conclu-sion as part of the discussion)?

  Yes

• Is the language appropriate, and is the text clear, precise and objective?

  Yes

• Was any indication of plagiarism observed in the manuscript?

  No

Suggestions/comments:

• The manuscript satisfactorily complies with the guidelines of the Revista Brasileira de Atividade Física e Saúde in terms of structure, language and originality, with no evident signs of plagiarism.

Abstract

• Are the abstract in Portuguese and the abstract in English adequate, containing the objective, infor-mation about the study participants, studied vari-ables, main results and a conclusion, and do they reflect the content of the manuscript?

  Partially

Suggestions/comments:

• In both the Portuguese abstract and the English abstract, there is an implicit conclusion of effec-tiveness and applicability of the program. However, given the importance of this study, the conclusion should be complemented with a stronger, more ex-plicit and conclusive final sentence, such as:

• “The results indicate that the VAMOS 2.0 program is a promising strategy for health promotion in Pri-mary Care.”

Introduction

• Was the research problem clearly stated and delim-ited?

  Yes

• Is the research problem adequately contextualized in relation to existing knowledge, moving from the general to the specific?

  Yes

• Are the reasons that justify the study, including the authors assumptions about the problem, well estab-lished in the writing?

  Yes

• Are the references used to support the presentation of the research problem current and relevant to the topic?

  Partially

• Was the objective clearly presented?

  Yes

Suggestions/comments:

• It would be useful to cite the original or most rec-ognized source of the RE AIM tool in the final paragraph to strengthen the conceptual foundation. The following reference is considered foundational and should be included, given that the study uses the RE AIM framework as its basis:

• Glasgow, R. E., Vogt, T. M., and Boles, S. M. (1999). Evaluating the public health impact of health pro-motion interventions: the RE AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322

• Another suggestion is to replace Reference 4 (VIG-ITEL 2014) with a more recent version, such as VIGITEL 2021 or 2022, available from the Ministry of Health website. This will strengthen the cur-rency of the statistical data presented in the article.

• Brazil. Ministry of Health. Secretariat of Health Surveillance. Department of Health Analysis and Surveillance of Non Communicable Diseases. Vig-itel Brasil 2021: surveillance of risk and protective factors for chronic diseases by telephone survey. Brasília: Ministry of Health, 2022.

Methods

• Are the methodological procedures generally ade-quate to study the research problem?

  Yes

• Are the methodological procedures adopted for conducting the study sufficiently detailed?

  Yes

• Was the procedure used to select or recruit partic-ipants adequate for the research problem and de-scribed in a sufficient, clear and objective manner?

  Partially

• Were information about the instruments used for data collection, their psychometric properties (for example reproducibility, internal consistency and validity) and, when pertinent, the operational defi-nition of variables presented?

  Yes

• Is the data analysis plan adequate and well de-scribed?

  Yes

• Were the inclusion and exclusion criteria for sample participants described and adequate for the study?

  Partially

• Did the authors provide clarification on the ethical procedures adopted in the research?

  Yes

Suggestions/comments:

• Recruitment procedures were standardized, but details are lacking regarding how participants were approached individually and whether there was se-lection bias, such as the predominance of women in the sample. I suggest including these details.

• The inclusion and exclusion criteria are not explic-itly described, which is a limitation. Page 3 lines 17 to 18 mention that the program targeted adults and older adults, but no information is provided about exclusions such as pre existing health conditions. This may affect the generalizability of the results. I request a more detailed description of the inclusion and exclusion criteria, including health conditions when possible.

• Page 3 lines 23 to 33 describe the multipliers and the online training. However, the manuscript does not state whether there was any evaluation of the training effectiveness. How was it determined that the multipliers were adequately trained? If an eval-uation existed, please include evidence demonstrat-ing the effectiveness of the training.

Results

• Is the use of tables and figures appropriate and does it facilitate the communication of the study results?

  Yes

• Is the number of illustrations in the article in ac-cordance with the guidelines for manuscript sub-mission?

  Yes

• Are the number of participants at each stage of the study, as well as the number and reasons for losses and refusals, presented in the manuscript?

  Partially

• Are the characteristics of the participants presented and sufficient?

  Partially

• Are the results adequately presented, highlighting the main findings and avoiding unnecessary repe-tition?

  Yes

Suggestions/comments:

• Ninety participants dropped out between recruit-ment and completion, representing a 39 percent loss. What reasons were reported by those who withdrew? There is no in depth analysis of the pro-file of participants who abandoned the program, which introduces selection bias. What strategies could be adopted by multipliers to improve reten-tion or adherence? I suggest including the reasons for dropout.

• Participant characteristics do not include information on comorbidities or motivation for participa-tion. If possible, I suggest including these details.

Discussion

• Are the main findings of the study presented?

  Yes

• Are the limitations and strengths of the study pre-sented and discussed?

  Yes

• Are the results discussed in light of the study limitations and existing knowledge?

  Yes

• Do the authors discuss the potential contributions of the main findings to scientific development, in-novation or real world interventions?

  Partially

Suggestions/comments:

• The study clearly presents its main findings, dis-cusses limitations and strengths, contextualizes results with existing literature and highlights im-portant contributions. However, I suggest the au-thors better emphasize how the results may guide public policies, particularly considering the specific challenges in the North and Central West regions regarding program adoption and increasing male adherence.

Conclusion

• Is the study conclusion adequately presented and coherent with the study objective?

  Yes

• Is the study conclusion original?

  Yes

Suggestions/comments:

• The conclusion is adequate, coherent and original, reinforcing the potential of the VAMOS Program as a health promotion strategy in Primary Care.

References

• Are the references up to date and sufficient?

  Yes

• Are most of them original research articles?

  Yes

• Do the references comply with the journal guide-lines regarding quantity and format?

  Yes

• Is in text citation adequate, meaning that state-ments cite references that substantiate them?

  Yes

Suggestions/comments:

• The references are updated, relevant and mostly based on original articles, matching the scope of the study.

• Minor formatting adjustments may be needed to align with journal guidelines, such as using italics for journal names and consistent abbreviations.

• In a few cases, additional references may strengthen the statements.

• It would also be useful to cite the foundational RE AIM reference mentioned earlier.

• Another suggestion is to replace VIGITEL 2014 with a more recent edition such as VIGITEL 2021 or 2022 to strengthen the currency of epidemiolog-ical data.

Comments to the author

Dear Author,

• Congratulations on your work. The study “Promo-tion of an active and healthy lifestyle among Pri-mary Health Care users in Brazil: an evaluation of the VAMOS Program based on the RE AIM tool” provides relevant contributions to public health, especially the multidimensional evaluation of the program and its impact on the population.

• The study also fills an important gap by evaluating the VAMOS Program in Brazilian Primary Care using the RE AIM framework, offering valuable insights for public policies.

• However, small adjustments may strengthen its clarity and impact, such as strategies to expand reach, partnerships with community health work-ers, use of digital technologies, and addressing the specific challenges of the North and Central West regions, as well as strategies to increase male en-gagement.

• Your study already represents an important contri-bution to the field, and these suggestions aim only to further enhance its scientific and social impact.

Final decision

• Minor revisions required

• peer review recommendation: minor-revision

History

• Reviewed
  25 Apr 2025

Avaliação dos pareceristas

About the reviewer

Avaliador A

Formato

• O artigo atende às regras de preparação de manus-critos para submissão à Revista Brasileira de Ativi-dade Física e Saúde?

  Sim

• Em relação aos aspectos formais, o manuscrito está bem estruturado, contendo as seções: introdução, métodos, resultados e discussão (conclusão como parte da discussão)?

  Sim

• A linguagem é adequada, o texto é claro, preciso e objetivo?

  Sim

• Foi observado algum indício de Plágio no manus-crito?

  Não

Sugestões/comentários:

Nada a comentar

Resumo/abstract

• O resumo e o abstract são adequados (contendo: objetivo, informações sobre os participantes do estudo, variáveis estudadas, principais resultados e uma conclusão) e retratam o conteúdo do manus-crito?

  Sim

Sugestões/comentários:

Nada a comentar

Introdução

• O problema de pesquisa foi claramente explicitado e delimitado?

  Sim

• O problema de pesquisa está adequadamente con-textualizado em relação ao conhecimento já dispo-nível, partindo do geral para o específico?

  Sim

• As razões que justificam (incluindo as pressuposi-ções dos autores sobre o problema) as necessidades do estudo estão bem estabelecidas na redação?

  Sim

• As referências utilizadas para apoiar a apresentação do problema de pesquisa são atuais e pertinentes à temática?

  Sim

• O objetivo foi claramente apresentado?

  Sim

Sugestões/comentários:

Nada a comentar

Métodos

• Os procedimentos metodológicos são, de modo ge-ral, adequados ao estudo do problema de pesquisa?

  Sim

• Os procedimentos metodológicos adotados para a realização do estudo estão suficientemente detalha-dos?

  Sim

• O procedimento adotado para seleção ou recruta-mento dos participantes foi adequado para o pro-blema estudado e está descrito de forma suficiente, clara e objetiva?

  Sim

• Foram apresentadas informações sobre os instru-mentos utilizados na coleta de dados, suas qualida-des psicométricas (por exemplo, reprodutibilidade, consistência interna e validade) e, quando pertinen-te, sobre a definição operacional das variáveis?

  Sim

• O plano de análise de dados é adequado e está ade-quadamente descrito?

  Sim

• Os critérios de inclusão e/ou exclusão de partici-pantes da amostra foram descritos e estão adequa-dos para o estudo?

  Sim

• Os autores forneceram esclarecimentos sobre os procedimentos éticos adotados para a realização da pesquisa?

• Em parte

Sugestões/comentários:

• Fiquei em dúvida sobre o CEP. Já foi ou não apro-vado

Resultados

• O uso de tabelas e figuras é apropriado e facilita a adequada veiculação dos resultados do estudo?

  Sim

• A quantidade de ilustrações no artigo está de acordo com o que é estabelecido pelas normas para sub-missão de manuscritos à revista?

  Sim

• O número de participantes em cada etapa do estu-do, assim como o número e as razões para as perdas e recusas estão apresentadas no manuscrito?

  Sim

• As características dos participantes estão apresenta-das e são suficientes?

  Sim

• Os resultados estão apresentados de forma adequa-da, destacando-se os principais achados e evitandose repetições desnecessárias?

  Sim

Sugestões/comentários:

Nada a comentar

Discussão

• Os principais achados do estudo são apresentados?

  Sim

• As limitações e os pontos fortes do estudo são apre-sentados e discutidos?

  Sim

• Os resultados são discutidos à luz das limitações do estudo e do conhecimento já disponível sobre o as-sunto?

  Sim

• As contribuições potenciais dos principais achados do estudo para o desenvolvimento científico, inova-ção ou intervenção na realidade são discutidas pelos autores?

  Sim

Sugestões/comentários:

Nada a comentar

Conclusão

• A conclusão do estudo foi apresentada de forma adequada e é coerente com o objetivo do estudo?

  Sim

• A conclusão do estudo é original?

  Sim

Sugestões/comentários:

• Nada a comentar

Referências

• As referências são atualizadas e suficientes?

  Sim

• A maior parte é composta de referências de artigos originais?

  Sim

• As referências atendem as normas da revista [quan-tidade e formato]?

  Sim

• A citação no texto é adequada, ou seja, as afirmações no texto citam referências que de fato substanciam tais afirmações?

  Sim

Sugestões/comentários:

Nada a comentar

Comentários ao autor

• O texto está bem escrito e claro. Tenho apenas su-gestão de realizar as correções apontadas. Encontrei apenas dois erros de espaçamento entre palavras:

• linha 11 da página 1

• linha 26 da página 7

• Fiquei em dúvida sobre o CEP. Já foi ou não apro-vado.

Parecer final (decisão)

• Aceito para publicação no formato atual

• peer review recommendation: accept

History

• Reviewed
  25 Apr 2025

Avaliador B

About the reviewer

Avaliador B

Formato

• O artigo atende às regras de preparação de manus-critos para submissão à Revista Brasileira de Ativi-dade Física e Saúde?

  Sim

• Em relação aos aspectos formais, o manuscrito está bem estruturado, contendo as seções: introdução, métodos, resultados e discussão (conclusão como parte da discussão)?

  Sim

• A linguagem é adequada, o texto é claro, preciso e objetivo?

  Sim

• Foi observado algum indício de Plágio no manus-crito?

  Não

Sugestões/comentários:

• O manuscrito atende satisfatoriamente às regras da Revista Brasileira de Atividade Física e Saúde em: Estrutura, Linguagem e Originalidade, sem indí-cios evidentes de plágio.

Resumo/abstract

• O resumo e o abstract são adequados (contendo: objetivo, informações sobre os participantes do estudo, variáveis estudadas, principais resultados e uma conclusão) e retratam o conteúdo do manus-crito?

  Em parte

Sugestões/comentários:

• Tanto no resumo quanto no abstract, há uma con-clusão implícita de efetividade e aplicabilidade do programa. No entanto, diante da importância deste estudo, a conclusão precisa ser complementada com uma frase final mais forte, explícita e conclusiva, como: “Os resultados indicam que o programa VA-MOS 2.0 é uma estratégia promissora para a pro-moção da saúde na Atenção Primária.”

Introdução

• O problema de pesquisa foi claramente explicitado e delimitado?

  Sim

• O problema de pesquisa está adequadamente con-textualizado em relação ao conhecimento já dispo-nível, partindo do geral para o específico?

  Sim

• As razões que justificam (incluindo as pressuposi-ções dos autores sobre o problema) as necessidades do estudo estão bem estabelecidas na redação?

  Sim

• As referências utilizadas para apoiar a apresentação do problema de pesquisa são atuais e pertinentes à temática?

  Em parte

• O objetivo foi claramente apresentado?

  Sim

Sugestões/comentários:

• Seria bom citar a fonte original ou mais conheci-da da ferramenta RE-AIM no parágrafo final, para fortalecer a fundamentação. Essa referência é con-siderada a fundadora do modelo RE-AIM, e é im-portante incluí-la no artigo, considerando que usa a estrutura desta ferramenta como base.

• Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health pro-motion interventions: the RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322.

• Outra sugestão é substituir a Ref. 4 (VIGITEL 2014) por uma versão mais recente (como VIGITEL 2021 ou 2022), disponível no site do Ministé-rio da Saúde. Isso ajudará a fortalecer a atualidade dos dados estatísticos descritos neste artigo.

• Brasil. Ministério da Saúde. Secretaria de Vigilân-cia em Saúde. Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis. Vigitel Brasil 2021: vigilância de fatores de risco e prote-ção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociode-mográfica de fatores de risco e proteção para doen-ças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2021. Brasília: Ministério da Saúde; 2022. https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/svsa/vigitel/vi-gitel-brasil-2021-estimativas-sobre-frequencia-e-distribuicao-sociodemografica-de-fatores-de-ris-co-e-protecao-para-doencas-cronicas/view.

Métodos

• Os procedimentos metodológicos são, de modo ge-ral, adequados ao estudo do problema de pesquisa?

  Sim

• Os procedimentos metodológicos adotados para a rea-lização do estudo estão suficientemente detalhados?

  Sim

• O procedimento adotado para seleção ou recruta-mento dos participantes foi adequado para o pro-blema estudado e está descrito de forma suficiente, clara e objetiva?

  Em parte

• Foram apresentadas informações sobre os instru-mentos utilizados na coleta de dados, suas qualida-des psicométricas (por exemplo, reprodutibilidade, consistência interna e validade) e, quando pertinen-te, sobre a definição operacional das variáveis?

  Sim

• O plano de análise de dados é adequado e está ade-quadamente descrito?

  Sim

• Os critérios de inclusão e/ou exclusão de partici-pantes da amostra foram descritos e estão adequa-dos para o estudo?

  Em parte

• Os autores forneceram esclarecimentos sobre os procedimentos éticos adotados para a realização da pesquisa?

  Sim

Sugestões/comentários:

• Seleção ou Recrutamento dos Participantes: O recrutamento foi realizado por meio de estratégias pa-dronizadas. No entanto, faltam detalhes sobre como os participantes foram abordados individualmente e se houve viés de seleção (por exemplo, predominân-cia de mulheres na amostra).Sugiro a inclusão des-tes detalhes como os participantes foram abordados individualmente e se houve viés de seleção.

• Critérios de inclusão e/ou exclusão: Os critérios de inclusão/exclusão não estão explicitamente descri-tos no texto, o que é uma limitação. Página 3, linhas 17-18, é mencionado que o programa foi direcio-nado a adultos e idosos, mas não há informações sobre exclusões (por exemplo, condições de saúde pré-existentes). Isso poderia afetar a generalização dos resultados. Solicito a inclusão de uma descri-ção mais detalhada dos critérios de inclusão e/ou exclusão dos participantes, incluindo, se possível, condições de saúde pré-existentes dos participantes.

• Critérios de inclusão e avaliação dos multiplicadores: Página 3, linhas 23-33 descreve sobre os mul-tiplicadores e os treinamentos online. No entanto, não foi descrito se houve algum tipo de avaliação da efetividade do treinamento online dos multi-plicadores. Sendo assim, como se sabe se o treina-mento a estes multiplicadores foi efetivo? Existiu algum modo de avaliação que evidenciasse o quão aptos os multiplicadores estavam? Se sim, solicito, por gentileza, que incluam alguma evidência sobre a efetividade deste treinamento aos multiplicadores.

Resultados

• O uso de tabelas e figuras é apropriado e facilita a adequada veiculação dos resultados do estudo?

  Sim

• A quantidade de ilustrações no artigo está de acor-do com o que é estabelecido pelas normas para sub-missão de manuscritos à revista?

  Sim

• O número de participantes em cada etapa do estu-do, assim como o número e as razões para as perdas e recusas estão apresentadas no manuscrito?

  Em parte

• As características dos participantes estão apresenta-das e são suficientes?

  Em parte

• Os resultados estão apresentados de forma adequa-da, destacando-se os principais achados e evitando-se repetições desnecessárias?

  Sim

Sugestões/comentários:

• Perdas e recusas: 90 participantes desistiram entre recrutamento e conclusão (39% de perda). Quais foram os motivos relatados por estes participantes? Não há uma análise aprofundada sobre o perfil dos que abandonaram, configurando um viés de sele-ção. Quais estratégias poderiam ser utilizadas pelos multiplicadores para retenção ou aderência destes participantes? Sugiro incluir os motivos dos partici-pantes que abandonaram o VAMOS.

• Características dos participantes: Não há dados sobre comorbidades ou motivação para participação. Sugiro incluir, se possível, estas informações.

Discussão

• Os principais achados do estudo são apresentados?

  Sim

• As limitações e os pontos fortes do estudo são apre-sentados e discutidos?

  Sim

• Os resultados são discutidos à luz das limitações do estudo e do conhecimento já disponível sobre o as-sunto?

  Sim

• As contribuições potenciais dos principais achados do estudo para o desenvolvimento científico, inova-ção ou intervenção na realidade são discutidas pelos autores?

  Em parte

Sugestões/comentários:

• O estudo apresenta seus principais achados de for-ma clara, discute limitações e pontos fortes, con-textualiza os resultados com a literatura existente e destaca contribuições relevantes para a área. No entanto, sugiro que os autores destaquem melhor como os resultados podem orientar políticas públi-cas, em especial, frente aos os desafios específicos das regiões Norte e Centro-Oeste para adoção do programa e aumento da adesão masculina.

Conclusão

• A conclusão do estudo foi apresentada de forma adequada e é coerente com o objetivo do estudo?

  Sim

• A conclusão do estudo é original?

  Sim

Sugestões/comentários:

• A conclusão é adequada, coerente e original, refor-çando o potencial do Programa VAMOS como estratégia de promoção da saúde na APS.

Referências

• As referências são atualizadas e suficientes?

  Sim

• A maior parte é composta de referências de artigos originais?

  Sim

• As referências atendem as normas da revista [quan-tidade e formato]?

  Sim

• A citação no texto é adequada, ou seja, as afirmações no texto citam referências que de fato substanciam tais afirmações?

  Sim

Sugestões/comentários:

• As referências são atualizadas, relevantes e majori-tariamente baseadas em artigos originais, atenden-do ao escopo do estudo.

• Pequenos ajustes de formatação como padronizar formato conforme as diretrizes da revista-alvo (ex.: uso de itálico em nomes de revistas, abreviações consistentes).

• A citação no texto é adequada, com raras exceções onde mais referências seriam úteis.

• Além disso, seria bom citar a fonte original ou mais conhecida da ferramenta RE-AIM no parágrafo fi-nal, para fortalecer a fundamentação. Essa referên-cia é considerada a fundadora do modelo RE-AIM, e é importante incluí-la no artigo, considerando que usa a estrutura desta ferramenta como base.

• Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health pro-motion interventions: the RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322

• Outra sugestão é substituir a Ref. 4 (VIGITEL 2014) por uma versão mais recente (como VIGI-TEL 2021 ou 2022), disponível no site do Ministé-rio da Saúde. Isso ajudará a fortalecer a atualidade dos dados estatísticos descritos neste artigo.

• Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis. Vigitel Brasil 2021: vigilância de fatores de risco e prote-ção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociode-mográfica de fatores de risco e proteção para doen-ças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2021. Brasília: Ministério da Saúde; 2022. https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/svsa/vigitel/vi-gitel-brasil-2021-estimativas-sobre-frequencia-e-distribuicao-sociodemografica-de-fatores-de-ris-co-e-protecao-para-doencas-cronicas/view

Comentários ao autor

Prezado(a) Autor(a),

• Parabéns pelo trabalho! O estudo “Promoção de um estilo de vida ativo e saudável em usuários da Atenção Primária à Saúde no Brasil: um estudo do Programa VAMOS com base na ferramenta REAIM” apresenta contribuições relevantes para a área de saúde pública, com destaque para a avaliação multidimensional do programa e seus impactos na população.

• Além disso, o estudo preenche uma lacuna impor-tante ao avaliar o Programa VAMOS na APS brasi-leira utilizando a ferramenta RE-AIM, oferecendo insights valiosos para políticas públicas.

• No entanto, pequenos ajustes fortalecerão sua clare-za e impacto, dentre eles estratégias para ampliar o alcance, como parcerias com agentes comunitários, uso de tecnologias digitais e explorar os desafios específicos das regiões Norte e Centro-Oeste para adoção do programa, bem como estratégias para au-mentar a adesão masculina.

• Vale ressaltar que seu estudo já representa uma im-portante contribuição para a área, e essas sugestões visam apenas fortalecer ainda mais seu impacto científico e social.

Parecer final (decisão)

• Pequenas revisões necessárias

• peer review recommendation: minor-revision

History

• Reviewed
  25 Apr 2025

Publication Dates

• Publication in this collection
  29 May 2026
• Date of issue
  2026

History

• Received
  31 Jan 2025
• Reviewed
  25 Apr 2025
• Accepted
  06 Nov 2025