Physical Activity and Obesity in Canadian Women

Engaging women in decision-making about their heart health: a literature review with patients' perspective

Cardiovascular disease (CVD) remains the leading cause of death globally. Although the burden of CVD risk factors tends to be lower in women, they remain at higher risk of developing complications when affected by these risk factors. There is still a lack of awareness surrounding CVD in women, both from a patient's and a clinician's perspective, especially among visible minorities. However, women who are informed about their heart health and who engage in decision-making with their healthcare providers are more likely to modify their lifestyle, and improve their CVD risk. A patient-centered care approach benefits patients' physical and mental health, and is now considered gold-standard for efficient patient care. Engaging women in their heart health will contribute in closing the gap of healthcare disparities between men and women, arising from sociocultural, socioeconomic, and political factors. This comprehensive review of the literature discusses the importance of engaging women in decision-making surrounding their heart health and offers tools for an effective and culturally sensitive patient-provider relationship.

The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 2: Scope of the Problem

Background

This Atlas chapter summarizes the epidemiology of cardiovascular disease (CVD) in women in Canada, discusses sex and gender disparities, and examines the intersectionality between sex and other factors that play a prominent role in CVD outcomes in women, including gender, indigenous identity, ethnic variation, disability, and socioeconomic status.

Methods

CVD is the leading cause of premature death in Canadian women. Coronary artery disease, including myocardial infarction, and followed by stroke, accounts for the majority of CVD-related deaths in Canadian women. The majority of emergency department visits and hospitalizations by women are due to coronary artery disease, heart failure, and stroke. The effect of traditional cardiovascular risk factors and their association with increasing cardiovascular morbidity is unique in this group.

Results

Indigenous women in Canada experience increased CVD, linked to colonization and subsequent social, economic, and political challenges. Women from particular racial and ethnic backgrounds (ie, South Asian, Afro-Caribbean, Hispanic, and Chinese North American women) have greater CVD risk factors, and CVD risk in East Asian women increases with duration of stay in Canada.

Conclusions

Canadians living in northern, rural, remote, and on-reserve residences experience greater CVD morbidity, mortality, and risk factors. An increase in CVD risk among Canadian women has been linked with a background of lower socioeconomic status, and women with disabilities have an increased risk of adverse cardiac events.

Associations of physical activity at work and household income with obesity: a cross-sectional study among rural adults in Korea

OBJECTIVES

This study was performed to identify the effect of physical activity at work on obesity and to analyze the contribution of socioeconomic factors and health behaviors to this association, which has been relatively little studied.

METHODS

From the Korean National Cancer Center Community Cohort, a total of 5,587 adults (2,125 men; 3,462 women) aged more than 30 years living in rural areas were enrolled. Information on socio-demographic factors, health behaviors, and body mass index was gathered using face-to-face interviews and measurements of height and weight.

RESULTS

Inverse associations were identified between vigorous-intensity physical activity at work and obesity in both men and women, while no association was found between vigorous-intensity physical activity during leisure time and obesity. High household income was independently associated with a lower risk of obesity among those who had low levels of vigorous-intensity physical activity at work. Vigorous physical activity at work showed an inverse association with obesity in rural areas where heavy manual labor is common.

CONCLUSIONS

Our findings indicate the necessity to account for various types of physical activity to improve the assessment and prevention of obesity.

Identification of motives and barriers to physical activity of polish young mothers

BACKGROUND

The purpose of the study was to determine the level of physical activity of young mothers living in rural and urban areas and their free time budget. The article also aims to indicate motivating factors and barriers encountered during physical activity.

METHODS

A diagnostic survey method, including two survey IPAQ questionnaires - the long version and author's questionnaire, has been applied in the study. A representative sample consisted of 1064 young mothers who gave birth in 2017. Student T test and discriminate function analysis have been used in statistical analysis.

RESULTS

No significant difference appeared between young mothers from rural areas and urban areas in the level of physical activity. At the same time, the authors of the study identified several smaller differences when analyzing particular aspects of physical activity. Young mothers from rural areas more often declared their participation in physical activity to improve their physical condition and reduce pain complaints. On the other hand, young mothers from urban areas emphasized that physical activity helps them to strengthen self-confidence and improve their position in the family. In case of the main barriers to physical activity, both group of respondents pointed to the lack of money and interest in occasional events.

CONCLUSIONS

The main conclusion is that more efforts are needed is to strengthen family support and material status of young families. It is also important to eliminate infrastructure barriers, mostly in rural areas and raise awareness on the importance of health education.

From XS to XL Urban Nature: Examining Access to Different Types of Green Space Using a ‘Just Sustainabilities’ Framework

Different types of urban green spaces provide diverse benefits for human health and environmental sustainability, but most studies on access to green space focus on neighborhood parks, with less work on smaller or larger green spaces. In this study, we examined sociodemographic differences in access to green spaces of different sizes for 14,385 census block groups in 12 U.S. cities using a ‘just sustainabilities’ framework. We classified green spaces into street-level greenery (XS), neighborhood parks (S–L; walking and cycling access), and large parks (XL; walking, cycling, and driving access). We ran spatial filtering models at the census block group level using different thresholds based on transportation modes. We uncovered a complex picture of inequality, with consistent injustices for XS green space, and fewer injustices for S–L and XL green space based on socioeconomic status and age, and some instances of just distributions for S–L and XL green space based on race/ethnicity. Our findings present a concerning picture for ‘just sustainabilities’: the green space type that is most often part of sustainability and climate adaptation strategies—street greenery—is unjustly distributed, likely as a result of structural racism in U.S. institutions. By examining multimodal access to green spaces of different sizes, this study helps urban greening professionals develop more just and sustainable strategies.

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.

Gestational diabetes and hypertensive disorders of pregnancy as vascular risk signals: an overview and grading of the evidence

The occurrence of common pregnancy-related medical disorders identifies women at high risk of developing future vascular disease. Systematic reviews of cohort studies demonstrate that gestational diabetes confers a 7-fold risk increase for type 2 diabetes, and preeclampsia confers a 1.8-fold risk increase for type 2 diabetes and 3.4-fold risk increase for hypertension. Gestational diabetes and hypertensive disorders of pregnancy (HDP) increase the risk of premature vascular disease, but the 2-fold risk increase associated with preeclampsia is only partially explained by the development of traditional vascular risk factors. Despite the compelling evidence for gestational diabetes and HDP as vascular risk indicators, there are no published Canadian vascular prevention guidelines that recognize these postpartum women. In contrast, the 2011 American Heart Association guidelines on cardiovascular disease in women include gestational diabetes and HDP in their vascular risk assessment. Studies indicate that the importance surveillance of vascular risk factors in these women after pregnancy is underappreciated by the women themselves and their physicians. Although a prudent diet and physically active lifestyle were demonstrated to reduce diabetes risk in women with a gestational diabetes history in the American Diabetes Prevention Program trial, adoption of these health behaviours is low; qualitative studies confirm a need for tailored strategies that address barriers and provide social support. Further research is also needed on approaches to reduce vascular risk in women with a history of gestational diabetes and HDP. Otherwise, an early window of opportunity for chronic disease prevention in young, high-risk women will be missed.

Carrying the pain of abuse: gender-specific findings on the relationship between childhood physical abuse and obesity in adulthood

BACKGROUND

Childhood abuse has been associated with negative adult health outcomes, including obesity. This study sought to investigate the association between childhood physical abuse and adult obesity, while controlling for five clusters of potentially confounding factors: childhood stressors, socioeconomic indicators, marital status, health behaviors, and mental health.

METHODS

Representative data from the 2005 Canadian Community Health Survey were selected. The response rate was approximately 84%. Gender-specific logistic regression analyses determined the association between abuse and obesity, while controlling for age and race and five clusters of potentially confounding factors. Of the 12,590 respondents with complete data, 2,787 were obese and 976 reported physical abuse as a child or adolescent by someone close to them.

RESULTS

Among women with childhood physical abuse compared to no abuse, the odds of obesity were 35% higher, even when controlling for age, race, and the five clusters of factors (odds ratio (OR) = 1.35; 95% confidence interval (CI) = 1.09, 1.67). Childhood physical abuse was not associated with adult obesity among men (OR = 1.12; 95% CI = 0.82, 1.53).

CONCLUSIONS

This study provides one of the first population-based, gender-specific analyses of the association between childhood physical abuse and obesity controlling for a wide range of factors. The gender-specific findings require further exploration.

Stage of change of 6 health-related behaviors among patients with type 2 diabetes

AIMS

Assessing patients' current stage of change toward 6 healthy behaviors related to diabetes control. Behaviors studied were smoking cessation (2) regular exercise; (3) consuming 5 servings or more of fruits and vegetables; (4) decreasing intake of refined sugar; (5) reducing saturated fat; and (6) self monitoring of blood glucose (SMBG).

METHODS

Stage of change (SOC) for several diabetes control-related behaviors was assessed for 737 patients with type 2 diabetes using a staging algorithm. Socio-demographic data were collected by a structured interview-based questionnaire.

RESULTS

There was high degree of readiness toward consuming diets with less saturated fat and simple sugar. Very low degree of readiness was reported for self-monitoring of blood glucose on a regular bases and for practicing physical exercise. Half of the participants (50.9%) were in the precontemplation stage for consuming ≥5 servings of fruits and vegetables every day. Significant correlations were obtained between the degree of readiness for several behaviors (p<0.01). Age, gender, income and education were all related to the stage of change of the studied behaviors (p<0.01).

CONCLUSIONS

Patients with diabetes in Jordan are still in the pre-action stages for practicing exercise, consuming 5 servings or more of fruit and vegetable, and self-monitoring of blood glucose. The current finding suggests a need for nutritional education and interventions to raise awareness of lifestyle factors influencing glycemic control among diabetics.

Individual, social and environmental factors influencing physical activity levels and behaviours of multiethnic socio-economically disadvantaged urban mothers in Canada: a mixed methods approach

Background

Existing data provide little insight into the physical activity context of multiethnic socio-economically disadvantaged mothers in Canada. Our primary objectives were: (1) to use focus group methodology to develop tools to identify the individual, social, and environmental factors influencing utilitarian and leisure time physical activities (LTPA) of multiethnic SED mothers; and (2) to use a women specific physical activity survey tool to assess psychosocial barriers and supports and to quantify individual physical activity (PA) levels of multi-ethnic SED mothers in Canada.

Methods

Qualitative focus group sessions were conducted in West, Central and Eastern Canada with multiethnic SED mothers (n = 6 focus groups; n = 42 SED mothers) and with health and recreation professionals (HRPs) (n = 5 focus groups; n = 25 HRPs) involved in community PA programming for multiethnic SED mothers. Administration of the women specific Kaiser Physical Activity Survey (KPAS) tool was completed by consenting SED mothers (n = 59).

Results

More than half of SED mothers were employed and had higher total PA scores with occupation included than unemployed mothers. However, nearly 60% of both groups were overweight or obese. Barriers to LTPA included the lack of available, affordable and accessible LTPA programs that responded to cultural and social needs. Concerns for safety, nonsupportive cultural and social norms and the winter climate were identified as key barriers to both utilitarian and LTPA.

Conclusions

Findings show that multiethnic SED mothers experience many barriers to utilitarian and LTPA opportunities within their communities. The varying LTPA levels among these multi-ethnic SED mothers and the occurrence of overweight and obesity suggests that current LTPA programs are likely insufficient to maintain healthy body weights.

"Pause-2-Play": a pilot schoolbased obesity prevention program

OBJECTIVES: "Pause-2-Play" is an obesity prevention program targeting screen-related sedentary behaviours and increasing physical activity among elementary school students. The program consisted of a Behavioural Modification Curriculum and a Health Promoting Afterschool Program. This pilot study reports program feasibility, practicability, and impact. METHODS: the 12-week pilot program was implemented with 32 grade five and six students. Program feasibility and practicability were assessed using a qualitative approach. Intervention effects were assessed by comparing pre-post changes in BMI, body composition, fitness scores, screen time, and cognitive variables related to screening viewing behaviours. RESULTS: "Pause-2-Play" was perceived as a useful, fun program with numerous benefits including: children trying new snacks, feeling fitter and better about one's own body shape, and becoming more aware of a healthy lifestyle. The intervention resulted in a statistically significant reduction in percent body fat and an increase in fat-free mass index in overweight children; a decrease in waist circumference and an increase in fat-free mass index were observed in normal weight children. The intervention also statistically improved fitness scores in both normal weight and overweight children. CONCLUSIONS: "Pause-2-Play" was feasible, practical, and favourably changed body composition and fitness level.

Food-related lifestyles and their association to obesity in five European countries

This paper's objective is to investigate the associations between obesity and Food-Related Lifestyles (FRL) in five European countries. A cross-sectional web-based survey was carried out in Belgium, Denmark, Germany, Greece and Poland, January 2008, with quota samples on gender (male, female), age categories (20-44 and 45-70 years), and locality of residence (urban, rural). A total of 2437 respondents (51% women, 49% men; mean age 41.4 years, SD 13.1) participated. Obtained data included socio-demographic information, measure of the food-related lifestyle scale and self-reported weights and heights. Body Mass Index (in kg/m(2)) was calculated as weight (in kg) divided by the squared height (in m(2)). Individuals were classified as obese if BMI > or = 30. Logistic regressions were fitted for the aggregated sample and then by country with obese as dependent and socio-demographics and FRL were included as independents. The prevalence of obesity in the five countries is 22%. Europeans giving more importance to 'self-fulfilment' (odds = 1.18), 'planning of meals' (odds = 1.15), and preferring 'snacks vs. meals' (odds = 1.24) are more likely to be obese. Respondents were less likely to be obese if they attached lower levels of importance to the use of 'shopping lists' (odds = 0.87). The overall picture is that a stronger interest in health, organic products and freshness, within the FLR domain of quality aspects, is associated with 'not being obese'. This study has identified specific FRL dimensions as potential predictors of obesity. The resulting consumers' profiling can be used for targeted interventions for weight management in Europe.

Chronic diseases and risk factors in Canada's northern populations: longitudinal and geographic comparisons

OBJECTIVE

Chronic diseases are the leading cause of death and disability worldwide and place considerable burden on the Canadian health care system. This research investigates the self-reported prevalence of major chronic diseases and risk factors in northern Canadian populations and compares their prevalence to southern Canadian populations over time.

METHODS

Canadian Community Health Survey (CCHS) cycle 1.1 (2000/01) and 3.1 (2005) data were used for the analyses. Respondents 20 years old or greater in the Yukon, Northwest Territories, and Nunavut comprised the northern Canadian sample. Respondents in the same age group in the rest of Canada comprised the southern Canadian sample. Unadjusted and adjusted weighted prevalence estimates and confidence intervals were calculated and tested for significance using z-tests.

RESULTS

Northern Canadian respondents had significantly lower crude prevalence of self-reported hypertension, arthritis/rheumatism, diabetes, heart disease and stroke than southern Canadian respondents, although these associations did not remain significant after adjusting for age and sex. Northern Canadian respondents had significantly lower adjusted prevalence of any chronic disease. However, northern Canadian respondents had significantly higher adjusted prevalence of obesity and smoking than southern Canadian respondents at both time periods. The prevalence of any chronic disease increased significantly from 2000/01-2005 for both northern and southern Canadian respondents.

DISCUSSION

The higher prevalence of key chronic disease risk factors in northern Canadian populations and the increasing prevalence for many chronic diseases in both southern and northern populations signal a need for continual monitoring of chronic diseases and the development of appropriate prevention and management strategies.

DiabetAction: changes in physical activity practice, fitness, and metabolic syndrome in type 2 diabetic and at-risk individuals

OBJECTIVE

To study the changes in physical activity (PA) level, body composition, fitness, and health parameters after the DiabetAction program and evaluate if PA level was maintained during follow-up.

DESIGN

The design of this quasi-experimental study was 1-group pre-test and post-test.

SETTINGS

The study was conducted at the sport center (CEPSUM) of the University of Montreal.

PARTICIPANTS

Out of the 39 subjects from different ethnic backgrounds with type 2 diabetes (T2D) or risk factors (obesity, insulin resistance, or familial history of T2D) who joined the program, 29 subjects took part in at least 50% of group sessions and performed post-intervention evaluations. Analyses were done using those 29 participants.

INTERVENTION

DiabetAction is a 10-week program designed for health and exercise professionals who want to introduce type 2 diabetic (T2D) and at-risk individuals to various modalities of exercise (cardiovascular, resistance, flexibility, and balance) in order to increase activity levels.

MAIN OUTCOME MEASUREMENTS

PA level, aerobic capacity, hand grip strength, dynamic balance, anthropometry, resting heart rate and blood pressure, fasting blood lipids and glucose, and metabolic syndrome prevalence.

RESULTS

A significant increase in PA practice was observed after the 10-week program, and more importantly was maintained during the 6-month follow-up. Significant increases in aerobic capacity, muscular strength at the hand, and high-density lipoprotein cholesterol were also observed post-intervention. After the program, significant reductions in body weight, waist circumference, skinfolds thickness, resting heart rate, and systolic blood pressure were reported. Overall, a reduction in the prevalence of metabolic syndrome was measured post-intervention.

CONCLUSION

Participants improved their fitness, cardiovascular risk factors, and PA level after their participation to the DiabetAction program, and those promising results justify further validation studies.

Walking behaviour and glycemic control in type 2 diabetes: seasonal and gender differences--study design and methods

Background

The high glucose levels typically occurring among adults with type 2 diabetes contribute to blood vessel injury and complications such as blindness, kidney failure, heart disease, and stroke. Higher physical activity levels are associated with improved glycemic control, as measured by hemoglobin A1C. A 1% absolute increase in A1C is associated with an 18% increased risk for heart disease or stroke. Among Canadians with type 2 diabetes, we postulate that declines in walking associated with colder temperatures and inclement weather may contribute to annual post-winter increases in A1C levels.

Methods

During this prospective cohort study being conducted in Montreal, Quebec, Canada, 100 men and 100 women with type 2 diabetes will undergo four assessments (once per season) over a one-year period of observation. These assessments include (1) use of a pedometer with a concealed viewing window for a two-week period to measure walking (2) a study centre visit during which venous blood is sampled for A1C, anthropometrics are assessed, and questionnaires are completed for measurement of other factors that may influence walking and/or A1C (e.g. food frequency, depressive symptomology, medications). The relationship between spring-fall A1C difference and winter-summer difference in steps/day will be examined through multivariate linear regression models adjusted for possible confounding. Interpretation of findings by researchers in conjunction with potential knowledge "users" (e.g. health professionals, patient groups) will guide knowledge translation efforts.

Discussion

Although we cannot alter weather patterns to favour active lifestyles, we can design treatment strategies that take seasonal and weather-related variations into account. For example, demonstration of seasonal variation of A1C levels among Canadian men and women with T2D and greater understanding of its determinants could lead to (1) targeting physical activity levels to remain at or exceed peak values achieved during more favourable weather conditions. Strategies may include shifting to indoor activities or adapting to less favourable conditions (e.g. appropriate outdoor garments, more frequent but shorter duration periods of activity) (2) increasing dose/number of glucose-lowering medications during the winter and reducing these during the summer, in anticipation of seasonal variations (3) examining the impact of bright light therapy on activity and A1C among T2D patients with an increase in depressive symptomology when sunlight hours decline.

Obesity in Canada: where and how many?

CONTEXT

Obesity rates are rising sharply among all industrialized countries; the situation seems to be worse in English speaking countries. Taking into account genetic predisposition, excess of caloric intake combined with low energy expenditure will usually result in obesity.

OBJECTIVES

To describe and compare regional obesity rates across Canada and assess the ecological relationship between regional rates of obesity, low level of leisure-time physical activity, and low fruit and vegetable consumption.

DESIGN

Cross-sectional population-based analysis from the 2003 Canadian Community Health Survey. MEASURES AND DATA ANALYSES: Canadian population distributions of body mass index (BMI), leisure-time physical activity and daily fruit and vegetable consumption were obtained from Statistics Canada. All these measures were based on the respondent's self-reported answers to a computer-assisted personal or telephone interview. Obesity rates (BMI> or =30), rates of low level of leisure-time physical activity (less than 1.5 kcal of energy expenditure per day), and rates of low fruit and vegetable consumption (less than five times a day) for the 106 Canadian Health regions were mapped to illustrate their geographical distribution. Cartograms were used in addition to traditional mapping to take into account the differences in population density between these small areas.

RESULTS

In 2003, 15.2% of Canadian individuals aged 20 years and older were considered obese. The rates of obesity varied substantially between the 106 Canadian health regions: from 6.2% in Vancouver to 47.5% in aboriginal population area. At the health region level, low leisure-time physical activity and low fruit and vegetable consumption are both good predictors of obesity (odds ratio of 9.2 and positive predictive value of 93% when considered simultaneously).

CONCLUSION

There is a strong gradient in obesity prevalence between Canadian health regions. At the regional level, high rates of low level of physical activity, and high rates of low fruit and vegetable consumption were both found good predictors of high rates of obesity.

Physical activity and ethnicity: evidence from the Canadian Community Health Survey

BACKGROUND

A large proportion of the Canadian population lives a sedentary lifestyle. Few data are available describing the physical activity behaviours among specific ethnic groups in Canada, so the purpose of this study is to examine the relationship between ethnicity and the level of self-reported physical activity.

METHODS

Pooled data from cycles 1.1 (2000/01) and 2.1 (2003) of the cross-sectional Canadian Community Health Survey (ages 20-64 yrs; N = 171,513) were used for this study. Weighted prevalences of self-reported leisure-time moderate (> or = 1.5 kcal x kg(-1) day(-1) (kkd)); moderate to high (> or = 3 kkd) and high physical activity (> or = 6 kkd) were calculated, and multiple logistic regression models were used to quantify the odds of being physically active across ethnic groups, after adjustment for several covariates (White referent group).

RESULTS

The rank order of prevalence of being moderately physically active by ethnicity was: White (49%), Other (48%), NA Aboriginal (47%), Latin American (40%), East/Southeast Asian (39%), Black (38%), West Asian/Arab (36%), South Asian (34%). Aboriginal men and women had the highest prevalences of being physically active at > or = 3 kkd (M = 32%, F = 22%) while East/Southeast Asian (19%) and East Asian/Arab men (19%), and South Asian women (12%) had the lowest prevalences. After accounting for covariates, Aboriginal men were at elevated odds of being physically active compared to Whites (> or = 3 kkd, OR=1.6, p < 0.05; > or = 6 kkd, OR = 2.7, p < 0.05). Only 7% and 3% of Canadian men and women, respectively, were active at > or = 6 kkd.

CONCLUSION

These results suggest that the prevalence of physically active Canadian adults varies by ethnicity. Strategies to promote physical activity and prevent physical inactivity should consider these findings.

Physical activity and immigrant status: evidence from the Canadian Community Health Survey

BACKGROUND

The immigrant population in Canada is diverse and growing, yet little is known about their physical activity behaviour and how it changes as they adapt to a Canadian lifestyle. This study extends the surveillance of physical activity in Canada to include the influence of time since immigration within and between ethnic groups.

METHODS

Pooled data from cycles 1.1 (2000/01) and 2.1 (2003) of the cross-sectional Canadian Community Health Survey (ages 20-64 y; N = 171,513) were used for this study. Weighted prevalences of self-reported leisure-time physical activity (> or = 3 kcal x kg(-1) x day(-1) (kkd)) were calculated, and unadjusted and adjusted (age, income, education, BMI) multiple logistic regression models were used to quantify the odds of being physically active (PA) (> or = 3 kkd) by time since immigration (recent immigrant < or = 10 yrs, immigrant >10 yrs, non-immigrant) within and between ethnic groups (White referent group).

RESULTS

The prevalence of recent immigrants (< or = 10 yrs) being PA (> or = 3 kkd) by ethnicity was: White (21%), Other (19%), Black (19%), Latin American (17%), West Asian/Arab (16%), East/Southeast Asian (14%), South Asian (11%). Recent immigrant Black men and White women had the highest prevalence of being PA (M = 27%, F = 18%) while South Asian men and women had the lowest prevalence (M = 14%, F = 9%). There is a gradient in the prevalence of being PA with recent immigrants (16%) < immigrants (20%) < non-immigrants (24%). Ethnic differences in the prevalence of being PA by time since immigration show similar patterns for men and women. Controlling for age, income, education and BMI had only small effects on the odds of being physical active across ethnicities and immigrant status.

CONCLUSION

These results suggest that physical activity levels vary according to immigrant status and self-ascribed ethnicity in Canadian adults. Strategies to promote physical activity and prevent physical inactivity should consider both ethnicity and time since immigration.

Physical activity and immigrant status: evidence from the Canadian Community Health Survey

BACKGROUND

The immigrant population in Canada is diverse and growing, yet little is known about their physical activity behaviour and how it changes as they adapt to a Canadian lifestyle. This study extends the surveillance of physical activity in Canada to include the influence of time since immigration within and between ethnic groups.

METHODS

Pooled data from cycles 1.1 (2000/01) and 2.1 (2003) of the cross-sectional Canadian Community Health Survey (ages 20-64 y; N = 171,513) were used for this study. Weighted prevalences of self-reported leisure-time physical activity (> or = 3 kcal x kg(-1) x day(-1) (kkd)) were calculated, and unadjusted and adjusted (age, income, education, BMI) multiple logistic regression models were used to quantify the odds of being physically active (PA) (> or = 3 kkd) by time since immigration (recent immigrant < or = 10 yrs, immigrant >10 yrs, non-immigrant) within and between ethnic groups (White referent group).

RESULTS

The prevalence of recent immigrants (< or = 10 yrs) being PA (> or = 3 kkd) by ethnicity was: White (21%), Other (19%), Black (19%), Latin American (17%), West Asian/Arab (16%), East/Southeast Asian (14%), South Asian (11%). Recent immigrant Black men and White women had the highest prevalence of being PA (M = 27%, F = 18%) while South Asian men and women had the lowest prevalence (M = 14%, F = 9%). There is a gradient in the prevalence of being PA with recent immigrants (16%) < immigrants (20%) < non-immigrants (24%). Ethnic differences in the prevalence of being PA by time since immigration show similar patterns for men and women. Controlling for age, income, education and BMI had only small effects on the odds of being physical active across ethnicities and immigrant status.

CONCLUSION

These results suggest that physical activity levels vary according to immigrant status and self-ascribed ethnicity in Canadian adults. Strategies to promote physical activity and prevent physical inactivity should consider both ethnicity and time since immigration.

Multi-level support for physical activity and healthy eating

AIM

This paper reports a study evaluating the relationship between social and community level supports and physical activity and dietary behaviours among a low-income Latino population with multiple chronic conditions.

BACKGROUND

With consistently lower physical activity than whites and documented nutritional deficiencies, Latinos in the United States of America represent a disproportionate share of the population with chronic illness. This pattern of health disparities is seen across countries, where there is a struggle to raise the health status of low-income, immigrant and aboriginal communities. Social-ecological theories of health behaviour stress the importance of considering social and community support for health behaviour, and represent a useful framework for considering ways to improve physical activity and nutrition for immigrant and aboriginal groups.

METHOD

We report here on data from a baseline assessment of 200 patients from a health clinic in the United States of America serving a low-income, primarily Latino population. Participants were enrolled in Resources for Health, a randomized controlled trial to promote multi-level support for chronic illness self-management. Measures included self-reported physical activity, dietary behaviour and multi-level support for chronic illness management as well as demographic data. Baseline data reported on here were collected between February 2002 and September 2003.

FINDINGS

Use of multi-level supports (e.g. family, individual and healthcare provider) was statistically significantly associated with meeting physical activity guidelines and better dietary behaviours. Being female and having multiple chronic conditions were also associated with better dietary behaviour. These variables explained 20% of the variance in dietary behaviour.

CONCLUSION

Results support a social-ecological approach for promoting healthy behaviour in this low-income, primarily Latino sample with multiple chronic conditions. Addressing multiple levels of support for healthy behaviour is important in interventions to improve physical activity and diet, and nurses may be particularly well placed to address such issues for low-income, aboriginal and immigrant patients with chronic conditions.