Introduction

Physical activity (PA) plays a fundamental role in daily life, being a source of social transformation and a potential strategy for health promotion.¹ Thirteen of the 17 objectives proposed for sustainable development can be achieved by encouraging PA, which integrates the global health agenda with goals to be achieved by 2030.² To this end, it is essential that teaching, research and politics adopt a holistic view of PA.¹

With regard to inequity, a study analyzing data from 111 countries showed the existence of inequities in the distribution of PA within countries, and observed that a large part was due to the low level of PA among women. According to the authors, in cities where it was possible to walk, PA was higher throughout the day in all age, sex and body mass index groups.³ Another study,⁴ developed in the European context, pointed out that socioeconomic inequalities assert the situation of morbimortality resulting from non-communicable chronic diseases. In this case, leisure time PA was linked to income level and social class, that is, to the socioeconomic status, and was less prevalent than occupational PA.

In Brazil, social inequities are quite expressive and interfere with the health of the population.⁵ Data from the 2013 edition of the National Health Survey (PNS)⁶ already pointed to important social inequalities in Brazilian adults, such as greater physical inactivity during leisure time among the least educated, individuals of Non-White race/skin color and among those without a private health insurance. Therefore, the present study aimed to analyze the sociodemographic indicators associated with engagement in PA in leisure time, transportation, domestic and occupational domains, based on data from the 2019 PNS.

Method

Results

Of the 94,114 households with residents aged ≥ 15 years, selected within the scope of the research, 90,846 were interviewed. Of those, 88,500 (53.2%; 95%CI 52.6;53.7 female individuals; mean age 45 ± 17.5 years) met the eligibility criteria and were analyzed. Sociodemographic information on the population can be seen in Table 1. It was found that 49.6% (95%CI 49.0;50.1) of the participants reported walking or cycling at least once a week. The prevalence of engagement in intense PA in the domestic context and at work was observed in 15.8% (95%CI 15.4;16.3) and 48.0% (95%CI 47.2;48.8) of the participants, respectively. In the context of leisure, 40.5% (95%CI 39.9;41.1) of the participants reported engaging in PA, highlighting walking 15.4% (95%CI 15.0;15.8), weight training 8.6% (95%CI 8.2;8.9) and sports 8.2% (95%CI 7.8;8.5) as the most frequent activities (Table 2).

Participants residing in rural areas were less likely to engage in PA in the transportation domain (OR = 0.67; 95%CI 0.63;0.71) and during leisure time (OR = 0.79; 95%CI 0.75; 0.85), and more likely to perform intense PA at work (OR = 1.61; 95%CI 1.49;1.74). Participants with higher income were more likely to engage in leisure time PA, and less likely to engage in PA in the transportation or occupational domains. Compared to males, females were more involved in domestic PA (OR = 2.85; 95%CI 2.63;3.08) and during transportation (OR = 1.21; 95%CI; 1.15;1.27), and less during leisure time (OR = 0.67; 95%CI 0.63;0.71) and at work (OR = 0.66; 95%CI 0.62;0.71). Participants of Black race/skin color were more likely to engage in domestic PA (OR = 1.15; 95%CI 1.02;1.28), during transportation (OR = 1.36; 95%CI 1.25;1.47) and at work (OR = 1.19; 95%CI 1.07;1.32) when compared to white individuals. It was found that longer working hours (> 40 hours per week) were associated with lower chances of engaging in domestic PA (OR = 0.71; 95%CI 0.62;0.80), during transportation (OR = 0.70; 95%CI 0.63;0.77) and during leisure time (OR = 0.74; 95%CI 0.66;0.82), and a greater chance of engaging in intense PA at work (OR = 1.71 ;95%CI 1.53;1.91) (Table 3).

The associations between sociodemographic indicators and the most frequent types of leisure time PA are shown in Table 4. Participants who lived in rural areas were more likely to practice sports (OR = 1.24; 95%CI 1.10;1.38) and less likely to choose other activities. Higher income levels were associated with greater engagement in all types of PA, most notably weight training (OR = 8.65; 95%CI 6.93;10.79), gymnastics (OR = 4.54; 95%CI 3.21;6.42), and running (OR = 5.22; 95%CI 3.59;7.58). Females chose walking (OR = 1.12; 95%CI 1.04;1.21) and aerobic gymnastics (OR = 3.90; 95%CI 3.08;4.95) more often, and were less inclined to engage in running (OR = 0.29; 95%CI 0.24;0.35), cycling (OR = 0.30; 95%CI 0.24;0.37), and sports (OR = 0.08; 95%CI 0.06;0.09).

Discussion

It is possible to identify multiple sociodemographic correlates for engagement in PA and PA typology in the investigated subgroups, when considering the domains of practice. Longer working hours, Black race/skin color, female sex, lower per capita income and level of education were associated with lower chances of engaging in leisure time PA. However, in this article, it is relevant to discuss the critical processes that are expressed in the association between sociodemographic indicators and the profile of PA engagement in the Brazilian population.

Given what has been pointed out, it can be observed that engagement in PA in Brazil is marked by socioeconomic inequities, which are the causes that account for the lower involvement in PA during leisure time by some groups and their higher level of engagement in activities in the occupational, transportation, and/or domestic domains, thus attesting a pattern of inequity that is socially reproduced, and which goes against what the Global Action Plan on PA advocates.²

It is important to point out that some ways of working and living are more harmful than others¹² and that health determinants can be external to the health care and treatment system. To put it another way, social inequities generate health inequities.¹³ This understanding is necessary for a critical epidemiology with the potential to be an important tool for monitoring, developing public health awareness and planning public actions aimed at protecting the health of the population. To do so, it is essential to deconstruct infertile obstacles between different currents of epidemiological thought, especially those erected between the traditions of classical epidemiology and social epidemiology.¹⁴

Structural determinants linked to the conflict between capital and work reverberate in the singular dimension of engagement in PA. In this sense, the discussion on the promotion of PA must take into account the tendency for time expropriation and recognize that, in a capitalist society, human activity will always face a fierce and unequal dispute over the subjects' available time.¹⁵ Therefore, this reflection cannot be separated from the right to leisure, health, non-degrading work and the objective living conditions that enable choices that are favorable to health.

The study identified a revealing association of this labor-capital conflict. Occupied individuals who are subjected to longer working hours are less involved in leisure time PA. This is due to the fact that part of the worker's time and energy is consumed by the labor activity.¹⁶ The findings also show an association between a low prevalence of leisure time PA and a high prevalence in the occupational domain in rural residents. These results are not random and can be attributed to the long working hours, the lack of incentives (support from the family, neighborhood) and the lack of appropriate space for the practice of PA.^17,18

An interesting issue unveiled by the study, with the potential to guide future research, is the significant volume of intense PA in the occupational domain in the Brazilian adult population. The rural population is more likely to have this concentrated volume during work, which would characterize an imbalance with demonstrably negative impacts on health.¹⁹ Researchers have observed that while engaging in leisure time PA is a choice made by the individual and which involves short durations of dynamic activities, with adequate resting time and consolidated health benefits, the opposite is observed for occupational PA.²⁰

This context requires measures that seek collective health awareness of the impact of PA in the different domains on rural health and, at the same time, that equip policymakers so that they can promote engagement in leisure time PA. To this end, it is necessary to strengthen discussions and justified claims, such as a reduction in working years for retirement, a reduction in working hours without cutting down wages, and an increase in resting time, along with ergonomic adjustments in the production environment and processes, in addition to programs that promote the dissemination and access to spaces for PA in rural areas.

Health inequities are not restricted to the health-disease process, but integrate other inequities in terms of access to and use of health services. A cross-sectional study with data from the 2013 PNS²¹ corroborates this understanding by evidencing that knowledge of public PA programs increased according to income, but those who participated in public PA programs more often were individuals with lower income.

However, some current forms of PA promotion reproduce inequalities by favoring socially and economically privileged groups.²² In recent years, the field of public health has shown greater interest in reflections and studies on social differentiation and inequity. This interest is expressed in public health policies, as is the case of the National Health Promotion Policy (PNPS).²³ Thus, in order to corroborate the understanding of the health-disease process in social groups which were invisible until then, themes such as class, sex, sexuality and ethnicity are given prominence, in an intersectional manner.

Women’s greater engagement in physical activities in the domestic context is representative of the social role shaped by the sexual division of labor, anchored in patriarchal capitalism.²⁴ Furthermore, the construction of femininity permeates the social hierarchy through biological aspects and the reproductive function, which generate, by means of work relationships, processes of domination and exploitation.²⁵

This differentiation process was highlighted by the type of leisure time PA chosen. Women tend to go walking and do aerobic gymnastics, while men engage in activities such as weight training and sports. These findings corroborate the analysis carried out in the 2013 PNS,²⁶ which showed that the practice of sports was less frequent among females. Another point identified in the 2013 PNS, and reinforced in the findings of the present study, was the continued engagement of females (18.4% in 2013 and 21.8% in 2019) compared to males (5.4% in 2013 and 9.1% in 2019) in PA in the domestic domain.²⁷

The ways of acting and behaving permeate relations of power and domination. Therefore, the construction of bodies must be considered as a political construction²⁸ and it is reflected in the way masculinity and femininity are understood and reproduced. Playing a sport is developed by reproducing behaviors which are considered acceptable and appropriate for either men or women, such as aggressiveness, passivity, domination, submission, virility and fragility.²⁹

Despite the unquestionable advances in the organization of a network of PA programs, the linear and pragmatic approach of the field still preponderantly points to a physical-sanitary, regulatory, healthcare and medicalizing rationale. PA is presumed to be the necessary remedy for the prevention of diseases and suffering that are socially reproduced, and it brings with it an understanding that reinforces the individualizing and blaming process, which sometimes generates isolated, episodic actions and strategies, which are and disconnected from the reality of the territories and their populations.

The notion of care is imbricated in the power relations between subjects, which standardizes and regulates the use of bodies.³⁰ Therefore, the maintenance of a hierarchical and vertical rationale, from planning and managing to executing programs, projects and actions focusing on PA, corroborates a discriminatory and excluding social dynamics. Therefore, there is an urgent need for a broader view of the concept of the benefits of PA that goes beyond the dominant justifications restricted to disease management and traditional physical health goals.

As for the limitations of the study, we emphasize that households located in special census sectors or with scarcely populated, such as indigenous and quilombola clusters, prisons and waterborne vessels, were excluded from the research sample. Consequently, some subgroups which are relevant to understand health inequities were not represented. Although this paper congregates researchers from different theoretical backgrounds, the approach undertaken does not enable a dialectical analysis that can explain the origin of each inequity revealed. Even so, it was possible to identify, quantify and discuss a series of processes of inequity in health that deserve specific studies.

The present research analyzed the sociodemographic indicators associated with engagement in PA in the different domains, revealing socioeconomic inequities for the domains of PA, due to which some groups are less likely to engage in PA during leisure time and more likely to do so in the occupational, transportation and/or domestic domains. This confirms a pattern of inequity that is socially reproduced, as inequalities arising from unfair social relations, which are avoidable, are evidenced, resulting in damage to health and life.

This pattern of inequity in the PA engagement profile was demonstrated in the subgroups with lower per capita income, people with longer working hours, those residing in rural areas, as well as women and individuals of Black race/skin color.

In this sense, the construction of public policies, programs and intersectoral and inter-institutional actions, especially those aimed at promoting PA, supported by the principles and guidelines of the Brazilian National Health (SUS), in a universal, equitable, participatory way and with a focus on social justice, need to consider aspects of social and sex differentiation, understanding that spaces aimed at promoting PA are sexed and socially hierarchical places.