Gregore’s research is focused on physical activity and sedentary behavior, aiming to create opportunities for improving public health.
Gregore has been involved in various population-based studies and has professional experience working on the Coordination of Chronic Non-Communicable Diseases Surveillance and Health Promotion in the Brazilian Ministry of Health.
In 2015, he came to Australia to join the UQ School of Human Movement and Nutrition Sciences as part of his PhD training.
During his short career, most of Gregore’s work has involved multidisciplinary research, transitioning from an early focus on physical education to the behavioral epidemiology of physical activity.
Gregore's interest is in measuring and understanding inequalities in population health, particularly about physical activity and sedentary behavior.
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This is the Physical Activity Researcher Podcast, a podcast for researchers of sedentary behavior, physical activity, and sports. Join for a relaxed dialogue about research design, practicalities, and well, anything related to research. Learn from your fellow researchers useful and relevant information that does not fit into formal content and limited space of scientific publications. And here is your host, researcher and entrepreneur, Ollie Tickenit. Welcome everyone. We have a great guest for this episode as we are talking about patterns of physical activity across the lifespan for prevention of chronic diseases. Our guest has done his PhD thesis related to socio-economic determinants and sedentary behavior in adolescence based on a data set from Praselian birth cohort study. Currently he is working as a research fellow at University of Queensland in Australia. Ladies and gentlemen, please welcome our guest, Dr. Krakor Miyok. Welcome, Krakor. Hi Ollie. Thank you very much. Thanks for having me here. It's a great pleasure to be here and have a nice chat. Yeah, pleasure to have you. So if we start with how do you approach physical activity in your research? So my research is basically the way that I see or I understand physical activity. It's I understand physical activity as a behavior that is determined by many factors and particularly or especially social context, cultural context, and other factors that lead someone to decide or to be active or inactive. So that is one one approach that I see the research and physical activity. So as from my PhD thesis, I start to gain interest in understanding what are the social determinants of physical activity and sedentary behavior, especially because I come from Brazil and because in Brazil, social inequalities or income inequalities are it's a huge big big problem and they impact a lot in physical activity. So that is kind of my background on understanding why some people are active or inactive. We focus on social determinants. So that is I'd say that is one arm of my research. The other arm of my research is understanding patterns of physical activity throughout the life course and understanding the different ways how people accumulate physical activity and how these different patterns of accumulation of physical activity, they impact health outcomes and which population of groups they are more likely to engage in different patterns of of physical activity. Yeah, that's that's really interesting. So so how do people actually accumulate their physical activity during their lifespan? So they accumulate that in many different ways and it actually did these really depends on the life stage that they are and by patterns of accumulation we can understand that in I think at least two different ways. So one is patterns of accumulation in a week or within a week a day. So it's actually what you do today and tomorrow and if you do physical activity in the morning, in the evenings, if you will spread your physical activity in one across the week or just do that in one two days or sessions per week. So that is one thing and you can also incorporate their different intensities. So you might be someone that do a lot of light intensity physical activity during the day and you don't do anything more vigorous but you also can see can be someone that does a lot of vigorous intensity activity. So this is one way to look at patterns and that varies by factors like age, employment, situation, socio-economic position that is also also related to the domains of physical activity where people do their physical activity whether for leisure time, for recreation or for transportation or for occupational physical activity. So this is one way to look at patterns in my point of view. The other way to look at patterns of accumulation of physical activity is more related to the amount of physical activity that you do in different parts of or periods of your life. So for example, you might relate to some of these patterns but I definitely relate to some of these patterns. So for example, you might be very, very active when you are adolescent and then became become inactive or opposite. You can be someone that was was very, very inactive and then became very active and we have a lot of change in physical activity during your life course and I think that one really interesting thing to some really interesting research questions that we have to still to respond are related to these different patterns of accumulation during the life course as well. So for example, if we just make the case and I'm using my personal example here, I'm a former athletes, let's say that way. So from my during my adolescence from when I was 13 years old until I was 21 years old, I was I was training for track and field basically running 400 meters. So basically I was training five, six days per week training a lot and then after that I stopped and I spent a lot of time doing more lighting things, you're not doing much physical activity. One of the questions that I have is to what extent, for example, all the physical activity that I accumulated early in my life actually impacts on my health now and in my health in the future. So this is I think is one way to understand patterns of physical activity or accumulation as well. Yeah, very, very interesting and and what kind of things you have found. You said that for example, some people are active when they are young and some are opposite. How does it is there some really interesting points related, for example, light intensity activity to moderate vigorous intensity activity that that we can kind of use in the in the promotion or policy that we can we can use. So some things that from my not only from my research but from the researchers that I've been working with in research that I'm not working with but they have been doing research in this field as well. We have some live transitions that really impact on physical activity. So for example, one of the one transition is the transition from adolescence to adulthood. That is change this activity and really usually that makes people decline their physical activity level because you start commitments. You go to the to uni start working. So physical activity just for many people don't it's not a priority anymore. So that is one thing. We have other periods in life as well that really change physical activity level of people. So recently I've been working more with women's health. Here in Australia we have some cohort studies that focus on women's health. For example, pregnancy has appeared of life that really impacts on physical activity of women. We just used I study from one of the studies from Pilates where we looked at physical activity levels before, during and after pregnancy in women. And we found that the it takes about four years after pregnancy women to return to their physical activity levels prior pregnancy. So this is one example of how a life event a major life event impacts on levels of physical activity. From Professor Wendy Brodert I work with here at UQ. She has some really interesting data about major life events and physical activity in women in different life stage. So basically what she found using data from this large study of women's health here in Australia is that physical activity in women decline from age from 20s to age 30s 40s really declines. And then from age 50 to 60s it increases again because for some of the reasons I because the children they leave home because it's it used to be the time when people retire. So basically you have more time. And then from age 70s, 80s, again, physical decline because physical function as well. So I think these are some of the events that some examples of events major life events that impact on physical activity as well. Yeah, interesting points. So you said that it takes four years after the pregnancy to get to the same levels. Have you studied what are the reasons is it like changed priorities in life or what what kind of things are affecting this one? So for these examples we are still exploring that but from previous research and from some preliminary analysis that we we've did from using this data. One major determinant of increasing levels of physical activity is availability and social support. And actually social support me in this case means people that could can look after the children of so and that actually is a more it's a cultural thing I would say. So it's kind of a social support in that sense that pregnant women or women postpartum they have social support they have family support they have support from the society as well. So then they can return to physical level. So that is one factor. Another factor that is really important I think is again and that comes to the social determinants of health and the importance of income and education for as a predictor of physical activity. We observed from these data from pelotonous for example that if we compare women with different levels of education so we have different different levels of formal education we observed the same pattern of decrease of physical activity and increase but women that are with that have high education that have a university degree they are much much more active than women that don't have that have like basic levels of education or they have only they had less than higher high school as well. And what is interesting or or sad actually is that if you look at women with low education their physical activity levels four years after after the pregnancy that is that level of physical activity is still lower than the physical activity level of women with higher education 12 months after pregnancy which is the period of the lowest level of physical activity in these time periods. So again it points out that physical activity and that's something that I really advocate for. It's not only a matter of choice. Physical activity is a matter of opportunity. It's a matter of the support that you receive. It's a matter of the the social environment that you are or the chance that you have to be active. It's not just a matter of okay I want to be active I'm gonna be active. So for example this specific case in women women can some women they it's not a priority so they would rather spend time with children than do physical activity. That's can be one case but for some women that's not the case because due to the social the cultural context for some women they have to take care of their children. So that is something that we need to consider when promoting physical activity my point of view. Yeah so so you said that the education is important factor how quickly women return to physical activity after pregnancy and and how do you see there's probably knowledge difference there's social support what kind of things are the most important if you have looked them more closely and what could we do to improve the situation. So in this case education it's a really apraxia of sociable in position. So it measures knowledge so usually women with higher education they have more access they have more knowledge of the benefits or their harms potential harms that's one thing. In specifically indicative Brazil and I think in I would say that these findings they can be applied to other countries as well but particularly in the Brazilian context that is a matter of access that people have to physical activity facilities. So for example in this study we actually assessed leisure time physical activity. In Brazil getting a little bit better now but leisure time physical activity is still restricted to private space. So if you want to do any leisure time physical activity you need to pay to have access to some facilities or to go to a public space usually those public space they are located in neighbors where women they are already from higher social composition groups. So that is one way that like social composition impacts physical activity. So in my point of view one way to overcome that it would be creating public policies that would help to develop facilities and improve access to physical activity facilities for women not only women but people with different social composition or background as well. And also increase safety of streets because that is a really important determinant of physical activity in women in women and old people as well all the people as well. So I think it's paying attention to paying attention to these details that would be something to be considered. And how do you see you have been doing studies from Brazilian data and so on how do you see the difference between low and middle-income countries and countries which are well off how do you see the differences there in the patterns and different things. So what I've seen is overall social determinants of physical activity are really important both in low and middle and high-income countries. So we tend to have the same pattern if we just think about leisure time, physical activity. People that are from high that have high social composition they tend to be more active in leisure time than people that have low social composition or are from low social composition groups. But and this is the only observation I don't have any specific data on that and that's something that is in my list of things to do. Overall the gaps or the difference between low and high social composition groups in terms of prevalence or levels of physical activity I think they are higher in low and middle social composition groups. Not because higher levels of physical activity in high social composition groups but because in low and middle-income countries the physical activity levels, leisure time physical activity levels in low social composition groups is really really low. So I think that is something to that is one observation that I have or that the gap is much much higher in low and middle income countries. This podcast is sponsored by Phibian. My name is Dr Paul Batman and I'd like to just say a few words about Phibian. I've used it a number of times on different projects that I've been involved in and find that it's incredibly reliable, very valid and incredibly sturdy. I love the graphics that come with it. It really is very clear and can easily see the active in and active periods as well. So I'd certainly recommend Phibian to anyone that's interested in finding out more about sedentary behavior particularly the concept of sitting and how we can possibly break it up with some really good valid information. Phibian from researchers to researchers. And how do you see related to research data and what kind of participants we have in the studies? I was doing recording with Andreas Holtermann and he was telling that most of the data we have about effects of physical activity come from from white-collar workers and we don't really have from blue-collar workers that for them they are actually really physically active so they need different kind of guidelines for their activity. How do you see this for the low and middle-income countries where probably more people are doing physical jobs and and there's many other differences. So how do you see do we have enough data from from these countries? That's a really important point. Both in terms of health promotion and promotion of physical activity but also in terms of research and understanding the causal links between physical activity and health outcomes. So I don't like to make it generalize that but yes we have many studies that explore the relationships between physical activity and health outcomes that were overrepresented of people that are healthy wise and healthy as Andreas had. So we need to think that most of the findings they are we can generalize mostly for these population groups right. So that is an important point. But also if we think about the findings that we have that come from study from studies conducted in low and middle-income countries and from studies that are from high-income countries. Most of the evidence that we have even from blue colors they are still coming from high-income countries and the context of movement the context in terms of the confounders that is something that's really important in observational research that is what most of us are doing or most of my colleagues do including myself. It's really important to consider. So if we think that the broad population I think is nearly 85% of the world's population live in low and middle-income countries. So 85% and more than or close to 90% of the research output they come from high-income countries. So basically we are doing research where people don't live or so this is really important to consider because all the causal links that we observed they come from a place where we don't have that do not represent the world population that's one point. And this is really important as I said before if we think about the relationships between confounders as a demographic confounders and feasibility or sedentary behavior this is really important to consider because if we do a study and we make adjustments in terms of analysis for confounders in a place where the population is quite homogeneous in terms of the confounders we still have the effect of the confounder in our finding. So we can't control for a potential confounder when there is not enough variability in our sample, right? So I think this is an important thing to consider. Yeah and how is it in your data when you have analyzed are you only looking like the lesser time physical activity and if not is it actually that more activity is better for the health outcome so how do you how is this this relationship? I've been looking more at leisure time physical activity, sedentary time and a little bit on transportation physical activity. I still haven't looked much on occupational physical activity so that that is something that I'm gain I'm interested I'm also interested but I'm aware that is sometimes the measure of physical activity occupational physical activity is not great so from a physical activity from from a promotion health promotion perspective I still believe that promoting leisure time physical activity and transportation or promoting physical activity in these two domains is really important and so I still I'm still focused more in leisure time and transportation physical activity. And yeah I don't know how is the length of the workdays for example in blue color working in Prasil but I would guess they are longer on average than for example in Denmark where the Andreas data comes from and and even in in a shorter days the occupational physical activity is actually already a health risk. Do you see that there's a big differences between between different countries in in this regard? It might be definitely might might be the case the pattern of accumulation of physical activity might be totally different the length of the daily work might be different as well that is a really that's a really really important point from Prasil from our data one of the reasons as well why I don't we don't have or the research that I've been involved doesn't focus much on occupational physical activity yet is because I've been working with some birth cohort studies from from Brazil and from this birth cohort studies we follow participants since they were born and at this time they are still young adolescents and only starting their adulthood or adult life so most of them are not exposed to occupational physical activity yet so we still don't have enough data or good good data to explore relationships between occupational physical activity and health outcomes from these birth cohort studies but definitely I'd see that I'd say that in four or five six years we'll be able to start to explore more and more the role of occupational physical activity on health outcomes in these cohort studies and and how you said that you also also have been examining the sedentary behavior so how does it look the the patterns of sedentary behavior so to exemplify or to give you an example of the patterns of sedentary behavior and the importance of having research in different countries I can share a few some of the findings from my PhD thesis where we look we did a systematic review with met analysis and we look at the relationship between so second on position and screen time in adolescence so the main finding from this study was that when you look at studies that investigated so second position in screen time in high-income countries we found a relationship we found that adolescents from low so second on position groups they they spent more time in school they spent they had more screen time so they spend more time sitting more time front of TV video games computer and so on so more so lower so second on position higher sitting time this isn't in high-income countries when you look at these studies that investigated data association in countries in low and middle-income countries we observed a different association so basically adolescents with high subject position they spend more time sitting more time in front of screen computer video games and this is really important because again if you think about health outcomes so if you think about health outcomes usually health outcomes they are much worse in people with low subject position right so when we investigate in high-income countries the relationship between high-sitting time and health outcomes it might be it might be with that some of these these effects of high-sitting time is not actually because of high-sitting time that is because we have in the high-sitting time group lots of people from low-source economic position with not with bad health outcomes right so when we observe that relationship is actually it's not a relationship caused by high-sitting time it's caused by low-source economic position this is one example but then the importance of having this same kind of analysis in low and middle-income countries is because if we actually if it's true that the high-sitting time cause X let's say here X that association should also be present in a in a context where high-source economic position that implies in good health or is related to good health is more is a determinant of high-sitting time does it make sense yeah it does make sense yeah yeah and and we have discussed now half an hour let's leave the transistence to adulthood in the second part but one one more question related to low and middle-income countries how do you see the the resources of researchers how how much you have research resources to actually do research in in these countries and what could be done to improve the situation that we would actually have have data from from there well that's a very important point only and actually good research it's only possible with funding regardless of where is where you you are in the world so good research it's only possible with funding with funding from long periods not short like short funding for studies that can be conducted in one two years like these cohort studies they are really expensive and they take years to be conducted unfortunately we have been seeing lots of research funding being cut in many different place and especially in low on I don't know if that's the case in all or in middle-income countries I can tell what's the situation in Brazil it's being dramatically cut the research findings for not only for health research but for science overall so that means that it's getting harder and harder to collect good quality data from in these countries usually to do research all the insumes everything that we need from research is we need to buy using what the current currency is dollars American dollars and then because the economies on this country sometimes is not great it makes much hard even harder to buy insumes and equipments to do research in good quality research there so I can't tell you like Brazil is a chaos now unfortunately and I was just reading the news today that the budget from the agents the main main research agents in Brazil that is the risk that is that agents it is possible to fund research all the research that we have in in a country with 200 million people so not only health health related research the budget from that agents for this year is gonna be only six million dollars so six million dollars is nothing that's what some research groups they receive in one single grant in other countries so just to make the contrast just to put that in context and how difficult that can be sometimes and let's not go too much into politics but I guess this is with the populist government and so it's kind of easy to cut the research it's it causes problems in the long run but maybe makes the economy looks better in a short one yeah maybe yeah yeah yeah and maybe last question how do you see the gender balance in in researchers and research participants in in for example in Brazil how how is the balance so we still need more research in women's health we still need more women as like in doing research in leader leadership of research we need more women in science definitely and we as society as a research community we definitely need to embrace we need to recognize that and we need to do I think everything that is in our power to increase participation of women in research and in research as well yeah yep that's that's good let's let's finish this part here so thank you Cracker for taking the part for this recording thank you very much it's my pleasure thanks for joining us this week on physical activity research through podcast if you like the show makes you never miss an episode by subscribing or following the show on Twitter this podcast is made possible by listeners like you thank 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