1) The study examined the effect of an 8-week exercise program on healthcare expenditures for patients in Brazil with hypertension or diabetes. 2) The results showed that expenditures for medical consultations and exams were significantly lower (by 32.7% and 100%, respectively) during the exercise period compared to the control period. 3) Expenditures for medicines were similar between the two periods, but patients with higher blood pressure or body fat at baseline experienced larger reductions in expenditures related to medicines and medical consultations, respectively, with the exercise program.

1. 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

2. Background
Over the last few
decades, The Brazilian
population has been
getting older and obese
Obesity (BMI ≥30kg/m2)
Overall Men Women

3. Figura: www.saude.gov.br
Figura: http://envolverde.com.br/portal/wp-content/uploads/2012/05/t71.jpg
KILSZTAJN et al. 2001
Background
Parallel 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

4. Scientific literature has pointed
out that physical inactivity
increases disease occurrence
and mortality in adults
Health care expenditures
increase too
Background

5. http://itatiaia.s3.amazonaws.com/wp-
content/uploads/2012/09/PATINANDOOO
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http://2.bp.blogspot.com/-
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N3A81tnJXo4/s1600/bike_shopper.jpg
http://observatorio.esportes.mg.gov.br/wp-
content/uploads/2013/10/www.pereirabarreto.sp_.
gov_.br_.jpg
Background
On 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

6. To analyze the effect of exercise
practice on primary health care
expenditures among Brazilian
patients.
Objective

7. Population:
207.610 inhabitants
HDI: 0.806
Brazil:
Sao Paulo State
Region: Western
Fonte: www.maps.google.com.br
Sampling Process
CITY: Presidente Prudente
Methods

8. Measure
1
6 months
Control period
Approved by the Ethics Research Board of Sao Paulo State University
Measure
2
Measure
3
8 weeks
Exercise
period
Methods
Inclusion Criteria:
Age ≥50 years-old
Diagnosis of arterial hypertension or diabetes mellitus
Medical records updated
Sample
50 patients were recruited in two basic health care units
There were 7 dropouts

9. 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

10. 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

11. 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 weeks
Number sections per week:
3 days
Intensity:
Moderate (reserve heart rate: 60% – 70%)
Exercise duration:
60 minutes
Type of activity:
Stretching, walking and resistance training
Figura: www.buscasaude.com.br/wp-
content/uploads/2011/08/atividade-fisica.jpg

12. 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

13. • 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

14. ResultsMedian
Wilcoxon test
p-value= 0.015
-32.7%
Medical Consultation
Expenditures in exercise period were 32.7% cheaper
than in control period

15. ResultsMedian
Wilcoxon test
p-value= 0.012
-100%
Exams
Expenditures in exercise period were 100% cheaper than
in control period

16. ResultsMedian
Wilcoxon test
p-value= 0.809
+7.5%
Medicines
Expenditures in exercise period were similar to control
period

17. ResultsMedian
Wilcoxon test
p-value= 0.187
-20%
Overall
Expenditures in exercise period were similar to control
period
Overall (US$)

18. Results
Patients with higher SBP and BF at baseline experienced
the largest reductions in expenditures related to medicines
and medical consultations, respectively

19. 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

20. 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!!!