The Agita São Paulo Program as a model for using physical activity to promote health

The "Agita São Paulo" Program applies a multilevel intervention approach to promoting physical activity among the 37 million inhabitants of the state of São Paulo, Brazil. The verb "agita" means to move the body, but the term also suggests changing the way of thinking and becoming a more active citizen. Since being launched in 1996, the Program has been widely copied throughout Brazil and in other countries of Latin America, and the World Health Organization has characterized it as a model for other developing countries. The Program aims to disseminate a clear and simple message to the community as well as establish partnerships with governmental and nongovernmental organizations and other entities. The Agita São Paulo message encourages people to adopt an active lifestyle by accumulating at least 30 minutes of moderate physical activity per day, on most days of the week. The Program has three main target groups: students, workers, and the elderly. The Program organizes "mega-events" that simultaneously reach and involve large numbers of people, and it also conducts ongoing activities with institutions that become partners of the Program. Intervention studies that the Program has carried out on specific, small groups have found both changes in behavior and an increasing awareness of the Program's name and message. In addition, surveys have found that a growing number of persons in the state of São Paulo have become aware of the Program and its message and have changed their physical activity level. A number of the special features of and lessons learned from the Agita São Paulo Program may have contributed to its success, including: a multisectorial approach; broad use of partnerships; the inclusion principle (avoiding messages or attitudes that might exclude any social group); the scientific basis for all the Program activities; the extensive free media coverage that the Program has received; a "two-hats" approach, using either governmental or nongovernmental methodologies to promote physical activity, depending on the circumstances; cultural adaptation (using local culture to disseminate the message and make its assimilation easier); encouraging activities that are pleasurable; the clear, simple, feasible message of promoting physical activity; and evaluation of the various Program efforts. These distinctive characteristics help make the Agita São Paulo Program a model that could be used in other countries as an effective way to promote health through physical activity.