Advancing Research and Practice in People, Health, and Place in Brazil: Using Community-Based System Dynamics to Identify Physical Activity Research Priorities.

Background: Brazil has made significant strides in promoting physical activity through research, policy, and large-scale programs. However, physical inactivity persists as a major risk factor for noncommunicable diseases, disproportionately affecting women, older adults, and low-income populations. Addressing this issue requires evidence-based approaches rooted in social justice, particularly within Brazil's complex social, economic, and spatial inequalities.

Methods: This study applied community-based system dynamics to engage health, urban planning, and social equity researchers to identify research priorities for promoting physical activity. Participants collaboratively developed causal loop diagrams using group model-building workshops to map the factors influencing physical activity across leisure and transport domains.

Results: These causal loop diagrams highlighted macro determinants, including public policies, urban infrastructure, and climate resilience, as key drivers of health equity. Through iterative refinement and expert consultation, the study identified 6 priority areas: monitoring inequalities, understanding social and environmental influences, assessing climate change impacts, evaluating policy and infrastructure effects, examining health impacts, and enhancing research methods. Participants prioritized these areas based on feasibility and importance, revealing the need for actionable research on health outcomes and practical interventions.

Conclusions: The findings underscore the importance of systems-oriented, place-based approaches to physical activity promotion. Addressing systemic inequalities, fostering equitable urban environments, and integrating health and climate goals are essential for advancing policies that support physical activity as a fundamental right in Brazil. This study provides a framework for aligning research, policy, and practice to promote physical activity, improve health equity, and enhance climate resilience.