Physical activity counseling and leisure-time physical activity among Brazilian adults in primary health care: a sex-stratified analysis

Background Primary health care is a key setting for promoting physical activity (PA), and counseling is one of the most commonly recommended strategies; however, evidence regarding potential sex differences in its effectiveness remains limited. Hence, we aimed to examine whether the association between received counseling and leisure-time physical activity (LTPA) differed according to sex among adult patients in primary health care in southern Brazil. Methods This cross-sectional study comprised a sample of 779 adults (70% women) from 15 basic health units. Counseling was defined as receiving PA advice from a healthcare professional during a consultation or while awaiting care at the facility. LTPA was evaluated using the International Physical Activity Questionnaire. PA was classified as an ordinal variable with three categories for walking, moderate PA, moderate-to-vigorous PA, and total LTPA (“no PA during the week”: 0–9 min/wk; “insufficiently active”: 10–149 min/wk; “sufficiently active”: ≥ 150 min/wk), as well as a separate classification for vigorous PA (“no vigorous PA during the week”: 0–9 min/wk; “insufficiently active”: 10–74 min/wk; “sufficiently active”: ≥ 75 min/wk). Results The prevalence of PA counseling was 43% (95% CI: 39.5–46.4%), and counseling was positively associated with walking only among men (OR: 1.83, 95% CI: 1.00–3.33, p = 0.050). Men who received PA counseling had 83.0% higher odds of reporting higher levels of walking compared to those who did not. However, the formal interaction test between counseling and sex was not statistically significant ( p = 0.334). Conclusion In sex-stratified analyses, PA counseling was positively associated with walking only among men. Although the formal interaction test did not support statistical effect modification by sex, the differences observed in the sex-stratified estimates warrant further investigation.