Effect of physical exercise implementation on mitigation of health care expenditures in

primary health care

Jamile Sanches Codogno1; Monique Yndawe Castanho Araújo1; Dayane Cristina Queiroz1; Débora Christante Cantaruti1; Rômulo

Araújo Fernandes1

Oslo, Norway, 2015

1. Laboratory of InVestigation in Exercise (LIVE), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil

Background

Over the last few decades, The Brazilian population has been

getting older and obese

Obesity (BMI ≥30kg/m2)

Overall Men Women

Figura: www.saude.gov.br

Figura: http://envolverde.com.br/portal/wp-content/uploads/2012/05/t71.jpg

KILSZTAJN et al. 2001

BackgroundParallel to the aging of population and increase of obesity prevalence,

health care expenditures have increased on Brazilian Public Health Care System (SUS), which attends ~60% of Brazilian citizens

Brazilian Constitution guarantees free access to health care services

Scientific literature has pointed out that physical inactivity

increases disease occurrence and mortality in adults

Health care expenditures increase too

Background

http://itatiaia.s3.amazonaws.com/wp-content/uploads/2012/09/PATINANDOOOO.jpg

http://2.bp.blogspot.com/-tOiBo3FxhNM/T_oz3U9OsFI/AAAAAAAAATY/N3A81tnJXo4/s1600/bike_shopper.jpg

http://observatorio.esportes.mg.gov.br/wp-content/uploads/2013/10/www.pereirabarreto.sp_.gov_.br_.jpg

BackgroundOn the other hand, although habitual physical activity has been related to the lower occurrence of diseases

The impact of physical exercise routines on

mitigation of health care costs remains unclear

To analyze the effect of exercise practice on primary health care expenditures among Brazilian

patients.

Objective

Population: 207.610 inhabitants

HDI: 0.806

Brazil:Sao Paulo State

Region: Western

Fonte: www.maps.google.com.br

Sampling ProcessCITY: Presidente Prudente

Methods

Measure1

6 months

Control period

Approved by the Ethics Research Board of Sao Paulo State University

Measure2

Measure3

8 weeks

Exercise period

Methods

Inclusion Criteria:Age ≥50 years-oldDiagnosis of arterial hypertension or diabetes mellitusMedical records updated

Sample50 patients were recruited in two basic health care unitsThere were 7 dropouts

Amostra

Blood pressure

Systolic blood pressure (mmHg)Diastolic blood pressure (mmHg)

(manual devices)

Metabolic variables Glucose (mg/dL) Triglycerides (mg/dL) Total cholesterol (mg/dL)

(portable devices [8-10h fasting])

Methods

Body fatness (bioelectrical impedance)

Amostra

Body composition

Body fatness in percentage (software provided by manufacturer)

All measurements were performed in the morning, at the Basic Health Care Unit and followed these recommendations: No coffee or alcohol consumption No exercise 24h before Empty bladder

Methods

Exercise Protocol

Methods

Recommendations for physical exercise practice in diabetic and hypertensive patients by Brazilian Societies of Hypertension and Diabetes

Medical doctors: released all patients to practice exercise at there own Basic health care unit.

Protocol duration: 8 weeksNumber sections per week: 3 daysIntensity: Moderate (reserve heart rate: 60% – 70%)Exercise duration: 60 minutesType of activity: Stretching, walking and resistance training

Figura: www.buscasaude.com.br/wp-content/uploads/2011/08/atividade-fisica.jpg

Health Care Expenditures

For each patient: all health care expenditures were assessed in the six months before the exercise practice (control period) and during 8 weeks of exercise protocol (experimental period)

Figura: www.camargopereira.blogspot.com

Methods

Monetary values in Brazilian currency (Real) were converted to US dollar

Medical consultations, Medicines, Exams and Overall

• Descriptive: Median• Wilcoxon test compared median values• Pearson correlation (r) analyzed the

relationship between variables. • Statistical significance was set at p-value

<0.05 (BioEstat [release 5.0])

Statistical Analysis

Methods

ResultsM

edia

n Wilcoxon testp-value= 0.015

-32.7%

Medical Consultation

Expenditures in exercise period were 32.7% cheaper than in control period

ResultsM

edia

n Wilcoxon testp-value= 0.012

-100%

Exams

Expenditures in exercise period were 100% cheaper than in control period

ResultsM

edia

n Wilcoxon testp-value= 0.809

+7.5%

Medicines

Expenditures in exercise period were similar to control period

ResultsM

edia

n

Wilcoxon testp-value= 0.187

-20%

Overall

Expenditures in exercise period were similar to control period

Overall (US$)

ResultsPatients with higher SBP and BF at baseline experienced the largest reductions in expenditures related to medicines

and medical consultations, respectively

Eight weeks of exercise practice was effective in the mitigation of health care expenditures related to medical consultations and exams.

Moreover, more visible reductions were observed in patients with higher body fatness

and systolic blood pressure values.

Conclusion

Jamile Sanches Codogno, PhD

Task Force of Research in Health, Physical activity and Economy

Laboratory of Investigation in Exercise (LIVE)

Department of Physical Education, School of Science and Technology, Sao Paulo State University (UNESP)

jamile@fct.unesp.br

Thank you!!!