{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T13:43:55Z","timestamp":1784382235703,"version":"3.55.0"},"reference-count":50,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004916","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Amazonas","doi-asserted-by":"crossref","award":["FAPEAM-StartUp para o SUS 012\/2022"],"award-info":[{"award-number":["FAPEAM-StartUp para o SUS 012\/2022"]}],"id":[{"id":"10.13039\/501100004916","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"crossref","award":["CAPES-001"],"award-info":[{"award-number":["CAPES-001"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Conselho Nacional de Pesquisa","award":["CNPq"],"award-info":[{"award-number":["CNPq"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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\u20130.79; 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.<\/jats:p>","DOI":"10.3390\/ijerph23030276","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:14:44Z","timestamp":1771928084000},"page":"276","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["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"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2559-6897","authenticated-orcid":false,"given":"Elisa Brosina","family":"de Leon","sequence":"first","affiliation":[{"name":"Graduate Program in Human Movement Sciences, Faculty of Physical Education and Physiotherapy, Federal University of Amazonas, Manaus 69067-005, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camila Fabiana Rossi","family":"Squarcini","sequence":"additional","affiliation":[{"name":"Professional Master\u2019s Program in Nursing, Department of Health Sciences, State University of Santa Cruz, Ilh\u00e9us 45662-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iasmin Machado","family":"Soares","sequence":"additional","affiliation":[{"name":"Graduate Program in Human Movement Sciences, Faculty of Physical Education and Physiotherapy, Federal University of Amazonas, Manaus 69067-005, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6919-8161","authenticated-orcid":false,"given":"H\u00e9rcules L\u00e1zaro Morais","family":"Campos","sequence":"additional","affiliation":[{"name":"Graduate Program in Human Movement Sciences, Faculty of Physical Education and Physiotherapy, Federal University of Amazonas, Manaus 69067-005, Brazil"},{"name":"Interdisciplinary Graduate Program in Rural Studies, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina 39100-000, Brazil"},{"name":"Institute of Health and Biotechnology, Federal University of Amazonas, Coari 69460-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael Martins da","family":"Costa","sequence":"additional","affiliation":[{"name":"Graduate Program in Human Movement Sciences, Faculty of Physical Education and Physiotherapy, Federal University of Amazonas, Manaus 69067-005, Brazil"},{"name":"Department of Physical Education, Health Center, Federal University of Rond\u00f4nia, Porto Velho 76801-059, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"ref_1","unstructured":"GBD 2021 Diabetes Collaborators (2023). 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