# Effect of a Community Health Worker-Led Intervention on Physical Activity in Adults with Type 2 Diabetes in Primary Health Care in the Brazilian Amazon

## TL;DR

A community health worker-led program helped increase physical activity among adults with type 2 diabetes in a low-resource area of Brazil.

## Contribution

Demonstrates that community health workers can effectively promote physical activity in underserved populations with diabetes.

## Key findings

- The intervention significantly increased the likelihood of engaging in moderate-to-vigorous physical activity.
- No significant effects were observed for active commuting or walking.
- Behavioral activation was effective among previously inactive participants.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Addressing physical inactivity among adults with type 2 diabetes, a major modifiable risk factor for disease progression and mortality.Evaluating a scalable, community-based strategy in a low-resource Amazonian context where access to health services is limited.

Addressing physical inactivity among adults with type 2 diabetes, a major modifiable risk factor for disease progression and mortality.

Evaluating a scalable, community-based strategy in a low-resource Amazonian context where access to health services is limited.

Public health significance—Why is this work of significance to public health?
Shows Community Health Worker-led interventions can reduce inactivity among adults with type 2 diabetes.Supports the Community Health Worker’s key role in diabetes self-management and behavior change in underserved populations.

Shows Community Health Worker-led interventions can reduce inactivity among adults with type 2 diabetes.

Supports the Community Health Worker’s key role in diabetes self-management and behavior change in underserved populations.

Public health implications—What are the key implications or messages for practitioners, policy makers, and/or researchers in public health?
Results highlight the need to integrate structured, theory-based CHW interventions into Primary Health Care to improve activity behaviors.Findings underscore the need for intersectoral approaches linking health services and urban planning to sustain increases in physical activity.

Results highlight the need to integrate structured, theory-based CHW interventions into Primary Health Care to improve activity behaviors.

Findings underscore the need for intersectoral approaches linking health services and urban planning to sustain increases in physical activity.

Type 2 diabetes mellitus (T2DM) is a major global public-health problem, and physical inactivity contributes to poor disease control. In settings with limited access to health services, as in the Brazilian Amazon, interventions delivered by Community Health Workers (CHWs) within Primary Health Care (PHC) may offer a pragmatic strategy to increase physical activity (PA). We aimed to evaluate the effect of a CHW-led, theory-based intervention on PA among adults with T2DM in PHC in a cluster-randomized, community-based trial. A total of 274 participants were enrolled (intervention: n = 140, control: n = 134). CHWs in the intervention group completed a blended training (e.g., asynchronous modules, printed educational materials, and hands-on guidance). They conducted six home visits over six months to support behavior change, including increased PA. PA was measured using the International PA Questionnaire (IPAQ-LF), which assessed active commuting, walking, moderate-to-vigorous PA (MVPA), and total PA. Group-by-time effects were examined using mixed-effects zero-inflated Gamma models. No significant intervention effects were observed for the conditional mean of minutes or the probability of participation in active commuting, walking, or total PA. However, for MVPA, the zero-inflated Gamma model revealed a significant intervention effect on the probability of engaging in activity. The intervention group showed a marked reduction in the likelihood of remaining at zero minutes of MVPA (Odds Ratio = 0.08; 95% CI = 0.01–0.79; p = 0.001) compared to the control group, indicating effective behavioral activation among previously inactive participants. These findings suggest that empowering CHWs to deliver structured, theory-driven interventions within PHC can reduce inactivity among high-risk adults with T2DM in underserved communities.