A scoping review of Indigenous community-specific physical activity measures developed with and for Indigenous Peoples in Canada, Australia, and New Zealand

Historical factors including colonization and ongoing socioeconomic inequities impact Indigenous Peoples' ability to mitigate chronic disease risks such as achieving recommended physical activity (PA) levels. Reliably assessing, reflecting, and promoting PA participation among Indigenous Peoples may be impacted by a lack of culturally appropriate assessment methods and meaningful engagement with Indigenous communities throughout the research process. The objectives of this scoping review were to examine: (1) How PA research with Indigenous Peoples used community-specific PA measures developed with and/or for Indigenous Peoples in Canada, Australia, and New Zealand; and (2) How the studies utilized community-based participatory research (CBPR) principles to engage communities. A systematic search was conducted in four electronic databases (Web of Science, Medline, University of Saskatchewan Indigenous Portal, and ProQuest Dissertations and Theses Global). Thirty-one (n = 31) articles were identified and data extracted for narrative synthesis. Studies using community-specific PA measures have been increasing over time. Adapting questionnaires to traditional Indigenous activities such as cultural dances, ceremonies, and food-gathering activities were the most frequent adjustments undertaken to use community-specific measures. There are, however, gaps in research partnering with communities with only 6% of studies including all eight CBPR principles. Practical ways researchers can engage Indigenous communities and build capacity such as training and employing community members were highlighted. More needs to be done to facilitate community self-determination and develop long-term sustainable initiatives. Using culturally appropriate and relevant methodologies including partnering with Indigenous communities may help identification and implementation of culturally relevant and sustainable health-promoting initiatives.

Real-Time Auditory Feedback-Induced Adaptation to Walking Among Seniors Using the Heel2Toe Sensor: Proof-of-Concept Study

Background

Evidence shows that gait training in older adults is effective in improving the gait pattern, but the effects abate with cessation of training. During gait training, therapists use a number of verbal and visual cues to place the heel first when stepping. This simple strategy changes posture from stooped to upright, lengthens the stride, stimulates pelvic and trunk rotation, and facilitates arm swing. These principles guided the development of the Heel2Toe sensor that provides real-time auditory feedback for each good step, in which the heel strikes first.

Objective

This feasibility study aimed (1) to contribute evidence toward the feasibility and efficacy potential for home use of the Heel2Toe sensor that provides real-time feedback and (2) to estimate changes in gait parameters after five training sessions using the sensor.

Methods

A pre-post study included 5 training sessions over 2 weeks in the community on a purposive sample of six seniors. Proportion of good steps, angular velocity (AV) at each step, and cadence over a 2- minute period were assessed as was usability and experience.

Results

All gait parameters, proportion of good steps, AV, and duration of walking bouts improved. The coefficient of variation of AV decreased, indicating consistency of stepping.

Conclusions

Efficacy potential and feasibility of the Heel2Toe sensor were demonstrated.

A systematic review of physical activity interventions to improve physical fitness and health outcomes among Indigenous adults living in Canada

The Indigenous population of Canada faces an increased burden of chronic disease, leading to decreased life expectancy. Physical activity is an important health behaviour that improves chronic disease risk factors and physical fitness. The objective of this systematic review was to evaluate physical activity interventions in the Indigenous population in Canada to determine effects on physical activity rates, physical fitness, and health outcomes. MEDLINE, PsycINFO, EMBASE, and CINAHL were searched for peer-reviewed journal articles. Inclusion criteria were studies that examined a physical activity intervention delivered in Indigenous communities in Canada for adults over 18 years of age. Data was extracted and two authors independently rated quality of the evidence. Five studies were included in the narrative synthesis. Interventions were community-based, and three were multi-component interventions focused on preventing or managing type II diabetes. The interventions varied in their success in altering physical activity rates, with increases (n = 2), a decrease (n = 1), or non-significant changes reported (n = 2). No study reported any measure of physical fitness. BMI was reported in four studies, with only one reporting a significant decrease. Decreases in systolic blood pressure and total cholesterol were reported in two studies. There is limited evidence and a lack of robust interventions that examine the impacts of physical activity on health and fitness status in the Canadian Indigenous population. Validated, culturally relevant tools for measuring physical activity may aid in program evaluation and focused educational materials could better support population health initiatives.

TRIAL REGISTRATION

The review protocol was registered prospectively with PROSPERO (registration number: CRD42017055363).

Culturally Relevant Physical Activity through Elders in Motion: Physical Activity Programming for Older Aboriginal Adults in the Northwest Territories, Canada

The 2011 National Household Survey found that the number of Aboriginal peoples in Canada aged 65 and over has increased by over 46 % since the 2006 Canadian Census (Statistics Canada 2011). Despite this dramatic increase in older Aboriginal peoples, there is a dearth of research concerning this cohort, especially regarding their engagement with physical activity. Using a case study methodology, this research sought to examine if the Northwest Territories (NWT) Recreation and Parks Association's (NWTRPA) Elders in Motion (EIM) program is culturally relevant for the participants. For this research we used a postcolonial theoretical framework since many of the participants in EIM are Aboriginal older adults and have experienced, and continue to experience, the effects of colonialism. To address this aim we conducted nine semi-structured interviews with EIM program leaders and NWTRPA staff, and supplemented these with archival research of EIM program documents. The findings show that the NWTRPA has adapted many EIM program documents for the participants and thus attempts to be culturally relevant for the participants. There are, however, aspects of the program that are not culturally relevant and actually reinforce colonialism, specifically with the program content (i.e. activities that are a part of EIM). In light of these findings, recommendations are offered for the NWTRPA on how the EIM program can become more culturally relevant for its Aboriginal participants.

Prevalence of overweight and obesity among indigenous populations in Canada: A systematic review and meta-analysis

Previous studies on overweight and obesity among indigenous peoples in Canada have been inconclusive. A systematic review was conducted on the prevalence of overweight and obesity among Canadian indigenous populations. Major bibliographic databases were searched for relevant studies published between January 1990 and June 2013. We reviewed 594 abstracts and included 41 studies in the meta-analyses. Using the heterogeneity test (Cochrane Q) results, the overall prevalence was estimated using fixed- or random-effects model. Nonadults (<18 years) had a pooled prevalence of overweight and obesity at 29.8% (95% CI: 25.2-34.4) and 26.5% (95% CI: 21.8-31.3), respectively. The pooled prevalence of overweight and obesity among adults were 29.7% (95% CI: 28.2-31.2) and 36.6% (95% CI: 32.9-40.2), respectively. Adult males had higher overweight prevalence than females (34.6% vs. 26.6%), but lower obesity prevalence (31.6% vs. 40.6%). Nonadult girls had higher prevalence than boys [overweight: 27.6%; 95% CI: 22.6-32.7 vs. 24.7%; 95% CI: 19.0-30.5; obesity: 28.6%; 95% CI: 20.3-36.9 vs. 25.1%; 95% CI: 13.8-36.4]. Nonadult Inuit had the highest overweight and lowest obesity prevalence. Although Inuit adult had the lowest prevalence of overweight (28.7%; 95% CI: 27.3-30.2) and obesity (32.3%; 95% CI: 25.5-39.1), it was relatively high. This study highlights the need for nutritional intervention programs for obesity prevention among indigenous populations in Canada.

Knowledge and awareness of Canadian Physical Activity and Sedentary Behaviour Guidelines: a synthesis of existing evidence

The aim of this review was to consolidate and synthesize existing evidence regarding current knowledge and awareness of the Canadian Physical Activity (PA) and Sedentary Behaviour (SB) Guidelines. MEDLINE, Embase, and PsycINFO were searched for peer-reviewed publications pertaining to the guidelines. Content experts, key organizations (i.e., ParticipACTION and the Canadian Fitness and Lifestyle Research Institute), journal Web sites, and service organizations (i.e., the Canadian Society for Exercise Physiology (CSEP) and the Public Health Agency of Canada) were consulted for additional evidence. Scientific publications (n = 6) and research from ParticipACTION and the Canadian Fitness and Lifestyle Research Institute reported that awareness of the guidelines is low, especially with respect to the SB guidelines. Less than 10% of survey respondents from the Canadian population were aware of the PA guidelines, and less than 5% were aware of the SB guidelines. Information on the guidelines was available on 51% of public health unit and CSEP partner Web sites. Online metrics (e.g., downloads, site accessions) from CSEP, the Public Health Agency of Canada, and journal Web sites showed that online accession of the guidelines was high (e.g., all “highly accessed” on journal Web sites). This review showed that awareness of the Canadian PA and SB Guidelines is low among the general population but higher among the scientific and stakeholder communities. Governmental, nongovernmental, and stakeholder organizations should collaborate in creating sustained, long-term, and well-resourced communication plans to reach the Canadian population to raise awareness of PA and SB guidelines and should implement programs to facilitate their uptake.

Contextual factors influencing leisure physical activity of urbanized indigenous adolescents

BACKGROUND/PURPOSE

Indigenous populations suffer from disparities in socioeconomic resources and health status. One approach to addressing these disparities is by targeting modifiable risk factors such as leisure physical activity (LPA). This study investigated and compared factors related to LPA among urbanized indigenous and nonindigenous adolescent students.

METHODS

This cross-sectional survey comprised fifth to ninth grade indigenous and nonindigenous students (n = 733). The nonindigenous students were matched with indigenous students on sex and academic achievement and used as a reference group. Data were collected through telephone interviews using structured questionnaires. Major items included: demographic characteristics; average time spent watching television per bout; participation in LPA; and stress and depression experiences.

RESULTS

With the exception of the duration of television watching per bout, Chi-square and independent t tests demonstrated that there were no significant differences between indigenous and nonindigenous adolescents in the selected LPA-related factors. Multiple logistic regression analysis including terms investigating interaction between ethnicity and the contextual factors included in this study indicated that the following factors were correlated with LPA participation: age [odds ratio (OR) = 0.82, 95% confidence interval (CI) = 0.71-0.94], male sex (OR = 1.77, 95%CI = 1.19-2.61), total hours spent watching television in the past 2 weeks (OR = 0.79, 95%CI = 0.63-0.99), life satisfaction (OR = 2.25, 95%CI = 1.04-4.90), and exercise enjoyment (OR = 3.40, 95%CI = 1.71-6.74). However, neither indigenous status (OR = 1.03, 95%CI = 0.19-5.79) nor any of the interaction terms reached the significant level.

CONCLUSION

No significant ethnic differences were found in LPA participation. LPA was significantly correlated with age, male sex, total time spent watching television, life satisfaction, and enjoyment of exercise.

Objectively measured physical activity and sedentary behaviour of Yakut (Sakha) adults

BACKGROUND

Circumpolar regions are undergoing social and economic transition, which often corresponds to a behavioural transition. Yet, physical activity and sedentary behaviour are rarely objectively measured within these groups.

AIM

This study aimed to characterize objectively measured physical activity and sedentary behaviour in a sample of indigenous Siberians.

SUBJECTS AND METHODS

Yakut (Sakha) adults (n = 68, 32 men) underwent anthropometry, interviews and wore a triaxial accelerometer for two days. Time spent in moderate-to-vigorous physical activity (MVPA) or sedentary behaviour was calculated using a single axis and also all three axes.

RESULTS

Men spent significantly more time in MVPA than women, although no sex difference was found in sedentary behaviour. Participants were far more active and less sedentary when classified using all three axes (vector magnitude) than a single axis. Television viewing time significantly related to sedentary behaviour in men only.

CONCLUSION

The Yakut have gender differences in amount and predictors of physical activity and sedentary behaviour. Triaxial accelerometry is more sensitive to daily physical activity in free living populations than single axis.

New Canadian Physical Activity Guidelines

The Canadian Society for Exercise Physiology (CSEP), in cooperation with ParticipACTION and other stakeholders, and with support from the Public Health Agency of Canada (PHAC), has developed the new Canadian Physical Activity Guidelines for Children (aged 5–11 years), Youth (aged 12–17 years), Adults (aged 18–64 years), and Older Adults (aged ≥65 years). The new guidelines include a preamble to provide context and specific guidelines for each age group. The entire guideline development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guidelines have gone through a rigorous and transparent developmental process; we based the recommendations herein on evidence from 3 systematic reviews, and the final guidelines benefitted from an extensive online and in-person consultation process with hundreds of stakeholders and key informants, both domestic and international. Since 2006, the products of our efforts resulted in the completion of 21 peer-reviewed journal articles (including 5 systematic reviews) that collectively guided this work. The process that Canadian researchers undertook to update the national physical activity guidelines represents the most current synthesis, interpretation, and application of the scientific evidence to date.