A Systematic Review of Interventions to Increase Physical Activity Among American Indian and Alaska Native Older Adults

Cardiovascular Disease Risk Factors in the Native American Population

Native Americans are disproportionately affected by cardiovascular disease in comparison with other racial and ethnic groups in the United States. Previous research has analyzed risk factors, quantified prevalence rates, and examined outcomes of cardiovascular disease in Native Americans, yet few studies have considered the role of societal and psychological factors on the increased burden of cardiovascular disease in Native Americans. Modifiable risk factors for cardiovascular disease, including poor nutrition, reduced physical activity, obesity, and increased substance use, are exacerbated in Native American communities due to cultural and historical factors. Further, Native Americans have endured historical trauma and continue to experience additional financial and healthcare stressors, resulting in increased levels of chronic stress. Chronic activation of stress responses through the hypothalamic-pituitary-adrenal and autonomic nervous system increases inflammation and cardiovascular dysfunction resulting in an increased risk for cardiovascular disease. Therefore, it is critical to examine the connection between these stressors and the cardiovascular health disparities in Native American communities to create effective strategies to improve health outcomes.

Clinical and sociodemographic determinants of older breast cancer survivors' reports of receiving advice about exercise

PURPOSE

Exercise offers various clinical benefits to older breast cancer survivors. However, studies report that healthcare providers may not regularly discuss exercise with their patients. We evaluated clinical and sociodemographic determinants of receiving advice about exercise from healthcare providers among older breast cancer survivors (aged ≥65 years).

METHODS

We used data from the Surveillance, Epidemiology, and End Results cancer registries linked to the Medicare Health Outcomes Survey (MHOS) from 2008 to 2015. We included female breast cancer survivors, aged ≥65 years, who completed the MHOS survey ≥2 years after a breast cancer diagnosis in a modified Poisson regression to identify clinical and sociodemographic determinants of reportedly receiving advice about exercise from healthcare providers.

RESULTS

The sample included 1,836 breast cancer survivors. The median age of the sample was 76 years (range: 72-81). Overall, 10.7% of the survivors were non-Hispanic Black, 10.1% were Hispanic, and 69.3% were non-Hispanic White. Only 52.3% reported receiving advice about exercise from a healthcare provider. Higher body mass index (BMI) and comorbid medical history that included diabetes, cardiovascular, or musculoskeletal disease were each associated with a higher likelihood of receiving exercise advice. Lower education levels, lower BMI, and never having been married were each associated with a lower likelihood of receiving exercise advice.

CONCLUSIONS

Nearly half of breast cancer survivors aged ≥65 years did not report receiving exercise advice from a healthcare provider, suggesting interventions are needed to improve exercise counseling between providers and survivors, especially with women with lower educational attainment who have never been married.

Association of Achievement of the American Heart Association's Life's Essential 8 Goals With Incident Cardiovascular Diseases in the SHFS

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in American Indian people. In 2022, the American Heart Association developed the Life's Essential 8 goals to promote cardiovascular health (CVH) for Americans, composed of diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, blood pressure, and blood glucose. We examined whether achievement of Life's Essential 8 goals was associated with incident CVD among SHFS (Strong Heart Family Study) participants.

METHODS AND RESULTS

A total of 2139 SHFS participants without CVD at baseline were included in analyses. We created a composite CVH score based on achievement of Life's Essential 8 goals, excluding sleep. Scores of 0 to 49 represented low CVH, 50 to 69 represented moderate CVH, and 70 to 100 represented high CVH. Incident CVD was defined as incident myocardial infarction, coronary heart disease, congestive heart failure, or stroke. Cox proportional hazard models were used to examine the relationship of CVH and incident CVD. The incidence rate of CVD at the 20-year follow-up was 7.43 per 1000 person-years. Compared with participants with low CVH, participants with moderate and high CVH had a lower risk of incident CVD; the hazard ratios and 95% CIs for incident CVD for moderate and high CVH were 0.52 (95% CI, 0.40-0.68) and 0.25 (95% CI, 0.14-0.44), respectively, after adjustment for age, sex, education, and study site.

CONCLUSIONS

Better CVH was associated with lower CVD risk which highlights the need for comprehensive public health interventions targeting CVH promotion to reduce CVD risk in American Indian communities.

Emplacing reablement co-creating an outdoor recreation model in the rural Arctic

Reablement aims to enable older persons with functional decline to re-engage in meaningful activities. The benefits of engagement in outdoor activities are significant; however, reablement services primarily target function in indoor environments whereas descriptions of outdoor activities are sparse. The aim of this study was to create a model that integrates outdoor recreation into reablement. We therefore elaborated on an experienced based co-design methodology to create a model that integrates outdoor recreation for older persons in reablement in an Arctic, rural context in northern Norway. Stakeholders (N = 35), including reablement participants, participated in workshops, focus groups, and individual interviews. Based on the results, we co-created a person-centred model for outdoor recreation in reablement, including an assessment tool that can guide reablement staff in goal-setting practices. Accordingly, we argue that cherished locations holds significant meaning in the lives of older people and warrant recognition in reablement programmes. There is a need to evaluate the effects and feasibility of the model and the possibility for its implementation in other health care settings.

Connecting and reconnecting to a community, with a sense of belonging - Exploring Aboriginal Elders' perspectives of engaging in a physical activity program

ISSUE ADDRESSED

Culturally appropriate physical activity (PA) programs have values and principles that respect local community culture and knowledge. However, in Western Australia (WA) there were no opportunities for older Aboriginal peoples to engage in a culturally appropriate PA program. The study objective was to explore how engaging in a culturally appropriate PA program impacted on the lived experiences of Aboriginal Elders.

METHODS

A qualitative exploratory study was conducted using an Indigenous methodology. Participants were Aboriginal Elders in Noongar Country in WA . Two groups, engaged in the Ironbark program, which consisted of weekly exercise and a yarning circle. The program was developed in NSW specifically for older Aboriginal and Torres Strait peoples and adapted for use in WA. Semi-structured interviews utilising a yarning approach were facilitated by a Noongar Wadjuk researcher. Inductive thematic analysis was undertaken.

RESULTS

Nineteen Elders were interviewed. The overarching theme was that participation led to connecting and reconnecting to community with a sense of belonging. Elders affirmed the program as being appropriate and comfortable. They described experiences that were grouped into three main themes of Positive mental and emotional changes, Physical improvements and Social benefits.

CONCLUSIONS

Aboriginal Elders valued the opportunity to engage in a culturally appropriate PA program. Benefits were appreciated as holistic in nature, with Elders seeing improvements in their mental, physical and emotional health. SO WHAT?: Increasing access to culturally appropriate, decolonised PA programs is a fundamental health promotion approach for working with older Aboriginal and Torres Strait Islander peoples.

Barriers and Enablers to Older Indigenous People Engaging in Physical Activity-A Qualitative Systematic Review

The objective of this qualitative systematic review was to synthesize all evidence to understand the barriers and enablers to older Indigenous peoples (aged 40 years and older) engaging in physical activity. Four databases were searched. Study quality was assessed from an Indigenous perspective, using an Aboriginal and Torres Strait Islander quality appraisal tool. Data were analyzed using thematic synthesis. There were 4,246 articles screened with 23 articles and one report included from over 30 Indigenous communities across four countries. Cultural Safety and Security was a key enabler, including developing physical activity programs which are led by Indigenous communities and preference Indigenous values. Colonization was a key barrier that created mistrust and uncertainty. Social Determinants of Health, including cost, were supported by successful programs, but if not addressed, were demotivators of engagement. Older Indigenous peoples identified barriers and enablers that can direct the development of sustainable, culturally appropriate physical activity programs.

Uplifting the voices of rural American Indian older adults to improve understanding of physical activity behavior

American Indian (AI) older adults experience pronounced health disparities and demonstrate one of the lowest levels of physical activity (PA) among racial and ethnic groups. Nearly half of AI older adults live in rural areas, indicating distinct challenges to participation in PA. Research to identify factors influencing PA in this population is missing from the literature, yet is critical to informing culturally relevant PA intervention development and implementation. The purpose was to identify barriers to and facilitators of PA among rural AI older adults using the ecological model and qualitative methods. A community-based approach was used to conduct semi-structured interviews with rural AI older adults. Interview questions were based on a multi-level ecological model. Content analysis was performed, using an iterative coding process to identify findings. The mean age of participants (n = 21) was 66 years. Barriers to and facilitators of PA were identified across ecological model levels. Barriers included factors such as caregiving and community responsibilities, lack of acceptable areas for walking, and overall lack of community-level support for older adult health. Facilitators included a personal connection to the land and ancestors through PA, multigenerational participation, and supportive tribal policies. This study addressed a gap in the literature by identifying barriers to and facilitators of PA among rural AI older adults, which can inform PA intervention development. With barriers and facilitators identified by AI older adults themselves, the voices of those directly affected are uplifted to shape efforts toward addressing longstanding health disparities through relevant public health interventions.