Prevalência de aconselhamento para atividade física na Atenção Básica à Saúde: uma revisão sistemática

Palavras-chave: Aconselhamento, Atividade motora, Atenção primária à saúde, Promoção a saúde


O aconselhamento tem se mostrado promissor para mudança de comportamento. Este estudo teve como objetivo realizar uma revisão sistemática sobre a prevalência de aconselhamento para a prática de atividade física oferecido pelos pro ssionais de saúde e recebido pelos usuários no contexto da Atenção Básica à Saúde. Foram revisadas as bases de periódicos PsycINFO, EBSCOhost, PubMed, ScienceDirect, Web of Science, LILACS e SciELO. O risco de viés foi avaliado em todos os artigos. Foram incluídos na revisão 44 artigos, destes, 21 investigaram aconselhamento fornecido por profissionais de saúde e 23 analisaram aconselhamento recebido por usuários. A prevalência de aconselhamento variou de 11,8% a 95,0% entre os profissionais (60,2 ± 22,7%) e 4,5% a 61,6% entre usuários (36,6 ± 14,2%). Médicos são os profissionais mais investigados. Usuários com fatores de risco para as doenças crônicas são os que mais relatam receber aconselhamento. O aconselhamento ainda é incipiente na Atenção Básica à Saúde, especialmente pela baixa percepção de aconselhamento recebido pelos usuários. Existe a necessidade de padronizar métodos para avaliar o aconselhamento para prática de atividade física, especialmente no tempo, no tipo e na forma de aconselhar.


Não há dados estatísticos.


Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insuficiente physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet Glob Health. 2018;6(10):1077-86.

Matthews CE, Cohen SS, Fowke JH, Han X, Xiao Q, Buchowski MS, et al. Physical activity, sedentary behavior, and cause-specific mortality in black and white adults in the Southern Community Cohort Study. Am J Epidemiol. 2014;180(4):394–405.

Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, et al. Effect of physical inactivity on major non-communicable diseases worlwide: na analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219-29.

Hallal PC, Andersen LB, Bull FC. Guthold R, Haskell W, Ekelund U, et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012;380(9838):247-57.

World Health Organization (WHO). Global recommendations on physical activity for health. Geneva: WHO; 2010.

Sallis JF, Bull F, Guthold R, Heath GW, Inoue S, Kelly P, et al. Progress in physical activity over the olympic quadrennium. Lancet. 2016;388(10051):1325-36.

Grossman DC, Bibbins-Domingo K, Curry SJ, Barry MJ, Davidson KW, Doubeni CA, et al. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors: US Preventive Services Task Force Recommendation Statement. JAMA. 2017;318(2);167-74.

Orrow G, Kinmonth AL, Sanderson S, Sutton S. Republished research: effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2013;47(1):e1389.

Williams NH. “The wise, for cure, on exercise depend”: physical activity interventions in primary care in Wales. Br J Sports Med. 2009;43(2):106-8.

Vuori IM, Lavie CJ, Blair SN. Physical activity promotion in the health care system. Mayo Clin Proc. 2013;88(12):1446-61.

Gagliardi AR, Abdallah F, Faulkner G, Ciliska D, Hicks A. Factors contributing to the effectiveness of physical activity counselling in primary care: a realist systematic review. Patient Educ Couns. 2015;98(4):412-9.

Hallal PC, Machado PT, Del Duca GF, Silva IC, Amorim TC, Borges TT, et al. Physical activity advice: short report from a population-based study in Brazil. J Phys Act Health. 2010;7(3):352-54.

Brasil. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde. Secretaria de Atenção à Saúde. Política Nacional de Promoção da Saúde. Brasília: MS; 2014. [citado 2018 jan 20]. Disponível em:

Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Atenção Básica. Brasília: MS; 2012. [citado 2018 jan 20]. Disponível em:

Florindo AA, Brownson RC, Mielke GI, Gomes GAO, Parra DC, Siqueira FV, et al. Association of knowledge, preventive counseling and personal health behaviors on physical activity and consumption of fruits or vegetables in community health workers. BMC Public Health. 2015;15(1):344.

Sanchez A, Bully P, Martinez C, Grandes G. Effectiveness of physical activity promotion intervention in primary care: a review of review. Prev Med. 2015;76(Supl.):56-67.

Jacobson DM, Strohecker L, Compton MT, Katz DL. Physical activity counseling in the adult primary care setting: position statement of the American College of Preventive Medicine. Am J Prev Med. 2005;29(2):158-62.

EU Working Group “Sport & Health”. EU Physical Activity Guidelines. Recommended Policy Actions in Support of Health-Enhancing Physical Activity. Brussels: EU; 2008.

Short CE, Hayman M, Rebar AL, Gunn KM, De Cocker K, Duncan MJ, et al. Physical activity recommendations from general practitioners in Australia. Results from a national survey. Aust N Z J Public Health. 2016;40(1):83-90.

Lawlor DA, Hanratty B. The effect of physical activity advice given in routine primary care consultations: a systematic review. J Public Health Med. 2001;23(3):219-26.

Petrella RJ, Lattanzio CN. Does counseling help patients get active? Systematic review of the literature. Can Fam Physician. 2002;48:72-80.

Hébert ET, Caughy MO, Shuval K. Primary care providers' perceptions of physical activity counselling in a clinical setting: a systematic review. Br J Sports Med. 2012;46(9):625-31.

Dacey ML, Kennedy MA, Polak R, Phillips EM. Physical activity counseling in medical school education: a systematic review. Med Educ Online. 2014;19(1):24325.

Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Health. 2015;13(3):147-53.

Aromataris E, Munn Z. Joanna Briggs Institute Reviewer´s Manual. The Joanna Briggs Institute. 2017. Disponível em:

Kreuter MW, Scharff DP, Brennan LK, Lukwago SN. Physician recommendations for diet and physical activity: which patients get advised to change?. Prev Med. 1997;26(6):825-33.

Bock C, Diehm C, Schneider S. Physical activity promotion in primary health care: results from a German physician survey. Eur J Gen Pract. 2012;18(2):86-91.

Buchholz SW, Purath J. Physical activity and physical fitness counseling patterns of adult nurse practitioners. J Am Acad Nurse Pract. 2007;19(2):86-92.

Burns KJ, Camaione DN, Chatterton CT. Prescription of physical activity by adult nurse practitioners: a national survey. Nurs Outlook. 2000;48(1);28-33.

Cho HJ, Sunwoo S, Song YM. Attitudes and reported practices of Korean primary care physicians for health promotion. Journal Korean Med Sci. 2003;18(6):783-90.

Douglas F, Torrance N, Van Teijlingen E, Meloni S, Kerr A. Primary care staff`s views and experiences related to routinely advising patients about physical activity. A questionnaire survey. BMC Public Health. 2006;6:138.

Florindo AA, Mielke GI, Gomes GAO, Ramos LR, Bracco MM, Parra DC, et al. Physical activity counseling in primary health care in Brazil: a national study on prevalence and associated factors. BMC Public Health 2013;13(1):794.

Grimstvedt ME, Der Ananian C, Keller C, Woolf K, Sebren A, Ainsworth B. Nurse practitioner and physician assistant physical activity counseling knowledge, confidence and practices. Prev Med. 2012;54(5);306-8.

Hidalgo KD, Mielke GI, Parra DC, Lobelo F, Simôes EJ, Gomes GO, et al. Health promoting practices and personal lifestyle behaviors of Brazillian health professionals. BMC Public Health. 2016;16(1):1114.

Joyce CL, O’Tuathaigh CM. Increased training of general practitioners in Ireland may increase the frequency of exercise counselling in patients with chronic illness: a cross-sectional study. Eur J Gen Pract. 2014;20(4):314-9.

Kennedy MF, Meeuwisse WH. Exercise counselling by family physicians in Canada. Prev Med. 2003;37(3):226-32.

Morishita Y, Miki A, Okada M, Tsuboi S, Ishibashi K, Ando Y, et al. Exercise counseling of primary care physicians in metabolic syndrome and cardiovascular diseases is associated with their specialty and exercise habits. Int J Gen Med. 2014;7:277-83.

Morris J, Nikolopoulos H, Berry T, Jain V, Vallis M, Piccinini-Vallis H, et al. Healthcare providers’ gestational weight gain counselling practises and the influence of knowledge and attitudes: a cross-sectional mixed methods study. BMJ Open. 2017;7(11):018527.

Omura JD, Bellissimo MP, Watson KB, Loustalot F, Fulton JE, Carlson SA. Primary care providers' physical activity counseling and referral practices and barriers for cardiovascular disease prevention. Prev Med. 2018;108:115-22.

Petrella RJ, Lattanzio CN, Overend TJ. Physical activity counseling and prescription among canadian primary care physicians. Arch Intern Med. 2007; 167(16):1774-81.

Puig RA, McKenna J, Riddoch C. Attitudes and practices of physicians and nurses regarding physical activity promotion in the Catalan primary health-care system. Eur J Public Health. 2005;15(6):569-75.

Santos TI, Guerra PH, Andrade DR, Florindo AA. Práticas pessoais e profissionais de promoção da atividade física em agentes comunitários de saúde. Rev Bras Ativ Fís Saúde. 2015;20(2);165-73.

Sherman SE, Hershman WY. Exercise counseling. How do general internists do? J Gen Intern Med. 1993;8(5);243-48.

Smith AW, Borowski LA, Liu B, Galuska DA, Signore C, Klabunde C, et al. U.S. primary care physicians' diet, physical activity, and weight-related care of adult patients. Am J Prev Med. 2011;41(1):33-42.

Walsh JM, Swangard DM, Davis T, McPhee SJ. Exercise counseling by primary care physicians in the era of managed care. Am J Prev Med. 1999;16(4):307-13.

Balde A, Figueras J, Hawking DA, Miller JR. Physician advice to the elderly about physical activity. J Aging and Phys Act. 2003;11(1):90-7.

Barbosa JMV, Souza WV, Ferreira RWM, Carvalho EMF, Cesse EAP, Fontbonne A. Correlates of physical activity counseling by health providers to patients with diabetes and hypertension attended by the Family Health Strategy in the state of Pernambuco, Brazil. Prim Care diabetes. 2017;11(4):327-36.

Croteau K, Schofield G. McLean G. Physical activity advice in the primary care setting: results of a population study in New Zealand. Aust N Z J Public Health. 2006;30(3);262-67.

Duro SM, Tomasi E, Siqueira FV, Silveira DS, Thumé E, Facchini LA. Adult physical activity counseling by health professionals in Brazil: a national urban population survey. J Phys Act Health. 2015;12(8):1177-83.

Flores TR, Gomes AP, Soares ALG, Nunes BP, Assunção MC, Gonçalves H, et al. Aconselhamento por profissionais de saúde e comportamentos saudáveis entre idosos: estudo de base populacional em Pelotas, sul do Brasil, 2014. Epidemiol Serv Saude. 2018;27(1):e201720112.

Forjuoh SN, Lee C, Won J, Towne SD, Wang S, Ory MG. Correlates of receiving a recommendation for more physical activity from a primary care provider. Am J Prev Med. 2017;52(2);207-14.

Glasgow RE, Eakin EG, Fisher EB, Bacak SJ, Brownson RC. Physician advice and support for physical activity: results from a national survey. Am J Prev Med. 2001;21(3):189-96.

Häfele V, Siqueira F. Aconselhamento para atividade física e mudança de comportamento em Unidades Básicas de Saúde. Rev Bras Ativ Fís Saúde. 2017;21(6):581-92.

Hinrichs T, Moschny A, Klaassen-Mielke R, Trampisch U, Thiem U, Platen P. General practitioner advice on physical activity: analyses in a cohort of older primary health care patients (getABI). BMC Fam Pract. 2011;12(1):26.

Klumbiene J, Petkeviciene J, Vaisvalavicius V, Miseviciene I. Advising overweight persons about diet and physical activity in primary health care: Lithuanian health behaviour monitoring study. BMC Public Health. 2006;6(1):30.

Ludt S, Petek D, Laux G, Van Lieshout J, Campbell SM, Kunzi B, et al. Recording of risk-factors and lifestyle counselling in patients at high risk for cardiovascular diseases in European primary care. Eur J Prev Cardiol. 2012;19(2):258-66.

Martínez-Gomez D, León-Muñoz LM, Guallar-Castillón P, López-Garcia E, Aguilera MT, Banegas JR, et al. Reach and equity of primary care-based counseling to promote walking among the adult population of Spain. J Sci Med Sport. 2013;16(6):532-8.

Pechter U, Suija K, Kordemets T, Kalda R, Maaroos HI. Physical activity and exercise counselling: a cross-sectional study of Family practice patients in Estonia. Qual Prim Care. 2012;20(5):355-63.

Santos RP, Horta PM, Souza CS, Santos CA, Oliveira HBS, Almeida LMR, et al. Aconselhamento sobre alimentação e atividade física: prática e adesão de usuários da atenção primária. Rev Gaúcha de Enferm. 2012;33(4):14-21.

Shuval K, DiPietro L, Skinner CS, Barlow CE, Morrow J, Goldsteen R, et al. ‘Sedentary behaviour counselling’: the next step in lifestyle counselling in primary care; pilot findings from the Rapid Assessment Disuse Index (RADI) study. Br J Sports Med. 2014;48(19):1451-5.

Silagy C, Muir J, Coulter A, Thorogood M, Yudkin P, Roe L. Lifestyle advice in general practice: rates recalled by patients. BMJ. 1992;305(6858):871-74.

Sinclair J, Lawson B, Burge F. Which patients receive on diet and exercise? Do certain characteristics affect whether they receive such advice?. Can Fam Physician. 2008;54(3):404-12.

Siqueira FV, Nahas MV, Facchini LA, Silveira DS, Piccini RX, Tomasi E, et al. Aconselhamento para a prática de atividade física como estratégia de educação à saúde. Cad. Saude Publica. 2009;25(1):203-13.

Tarasenko YN, Miller EA, Chen C, Schoenberg NE. Physical activity levels and counseling by health care providers in cancer survivors. Prev Med. 2017;99:211-17.

Wee CC, McCarthy EP, Davis RB, Phillips RS. Physician counseling about exercise. JAMA. 1999;282(16):1583-8.

Weidinger KA, Lovegreen SL, Elliot MB, Hagood L, Haire-Joshu D, McGill JB, et al. How to make exercise counseling more effective: lessons from rural America. J Fam Practic. 2008;57(6):394-402.

Bardach SH, Schoenberg NE, Howell BM. Older patient’s recall of lifestyle discussions in primary care. J Appl Gerontol. 2017;36(4):386-400.

Brasil. Ministério da Saúde.Vigitel Brasil 2017: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográficas de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2017. Brasília: MS; 2018.

World Health Organization (WHO). Global status report on noncommunicable diseases. Geneva: WHO; 2014.

World Health Organization (WHO). Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: WHO; 2013.

Tulloch H, Fortier M, Hogg W. Physical activity counseling in primary care: who has and who should be counseling?. Patient Educ Couns. 2006;64(1-3):6-20.

Brasil. Ministério da Saúde (MS). Cadernos de Atenção Básica. Núcleo de Apoio à Saúde da Família. Brasília: MS; 2014.

Fertonani HP, Pires DEP, Biff D, Scherer MDA. The health care model: concepts and challenges for primary health care in Brazil. Cienc Saúde Coletiva. 2015;20(6):1869-78.

Aittasalo M, Kukkonen-Harjula K, Toropainen E, Rinne M, Tokola K, Vasankari, T. Developing physical activity counseling in primary care through participatory action approach. BMC Fam Prac. 2016;17(141):1-15.

Berry LL, Flynn AG, Seiders K, Haws KL, Quach SQ. Physician counseling of overweight patients about preventive health behaviors. Am J Prev Med. 2014;46(3):297-302.

Jennings A, Barnes S, Okereke U, Welch A. Successful weight management and health behaviour change using a health trainer model. Perspect Public Health. 2013;133(4);221–6.

Hung OY, Keenan NL, Fang J. Physicians’ health habits are associated with lifestyle counseling for hypertensive patients. Am J Hypertens. 2013;26(2):201–8.

Lopes ACS, Toledo MTT, Câmara AMCS, Menzel HJK, Santos, LC. Condições de saúde e aconselhamento sobre alimentação e atividade física na Atenção Primária à Saúde de Belo Horizonte-MG. Epidemiol Serv Saúde. 2014;23(3);475-86.

Czeresnia D. O conceito de saúde e a diferença entre promoção e prevenção. In: Czeresnia D, Freitas CM (Org.). Promoção da Saúde: conceitos, práticas e reflexões. Rio de Janeiro: Fiocruz; 2003. p. 39-53.

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