Provider, father, and bro--Sedentary Māori men and their thoughts on physical activity

Physical activity and sedentary behavior perceptions in overweight and obese adults: A systematic review of qualitative study

Background

One of the largest hazards to human health is obesity, which is intimately related to sedentarism and physical inactivity. Understanding the perspectives and attitudes of adults with overweight or obesity towards their lifestyle choices related to sedentary behavior and physical activity is essential for mitigating associated health risks.

Objective

This systematic review aims to collate the extent of qualitative research on the perception of sedentary behavior and physical activity among adults with overweight and obesity.

Methods

A comprehensive search of Scopus, PubMed, CINAHL, and Web of Science, databases was conducted, which yielded 2,881 articles. A total of 2591 abstracts were screened, and 45 full-text articles were examined. A total of nine qualitative studies involving adults with overweight or obesity (BMI > 25 kg/m 2) were included in this systematic review. Data extraction utilized Rayyan.qcri.org software, and studies were critically appraised using Joanna Briggs's Institute checklist for qualitative research.

Results

The included studies revealed a diverse array of themes, wherein a few perceived factors reported towards sedentary behavior were lack of awareness about the hazards, mode of relaxation, family commitment, technology use, motivation deficits, and fatigue. Barriers to physical activity encompassed social, cultural, and environmental factors. In contrast, peer support, fitness facility access, accountability, mental health awareness, well-being, and weight management facilitate physical activity involvement.

Conclusion

Perceptions in overweight and obese adults on sedentary living and exercise are intricate and multifaceted. This review provides valuable insights that can inform clinicians and researchers in promoting regular physical activity for adults with overweight and obesity.

'Nih Waangkiny Kaadatjiny': 'Listening, learning and knowing': Stakeholders' perspectives about barriers and enablers to delivering a successful physical activity program for older Aboriginal people

There is limited evidence about how physical activity (PA) programs should be provided for older Aboriginal and Torres Strait Islander peoples. Recently two groups of Aboriginal Elders on Noongar Boodja (Country) in Western Australia participated in the Ironbark PA program.

ISSUE ADDRESSED

The objective of this study was to explore the views of key stakeholders about the barriers and enablers to delivering a successful PA program and provide feedback for future program delivery.

METHODS

The research took a 'Nih (listening), Waangkiny (learning), Kaadatjiny (knowing)' approach. The lead researcher, a Noongar Wadjuk woman, conducted semi-structured interviews (n = 17) with key stakeholders: Aboriginal and non-Aboriginal workers who assisted to deliver the program, and family and local members of the communities. Data were also collected through weekly program notes and researcher diary entries. Data were analysed thematically.

RESULTS

The overarching theme highlighted that stakeholders felt a sense of building a PA program that was culturally appropriate. They reflected that the program attracted older Aboriginal people because it was designed to make them feel welcomed with a sense of belonging. Five major themes were identified: Relationships, Belonging, Program structure, Benefits of the program and Future planning. Positive changes observed in Elders' health and well-being were a source of inspiration for team workers.

CONCLUSIONS

Key enablers to delivering a PA program for older Aboriginal people are building a culturally strong program that creates a sense of belonging for the participants. SO WHAT?: Practitioners who are planning PA programs for older Aboriginal people should prioritise the development of cultural safety and security.

Understanding how whānau-centred initiatives can improve Māori health in Aotearoa New Zealand

This article highlights the significance of prioritizing Indigenous voices and knowledge systems, using whānau-centred initiatives (a concept that encompasses the broader family and community) as a foundation for health promotion within an Indigenous context. Tū Kahikatea, a conceptual framework, is used to demonstrate the relationship between the values underpinning different whānau-centred initiatives and their corresponding outcomes. The framework highlights the capacity of whānau-centred initiatives to support whānau in attaining mana motuhake, which represents collective self-determination and the ability to exercise control over their own future. By doing so, these initiatives contribute to the improvement of whānau health outcomes. With recent changes to Aotearoa New Zealand's health system, the findings underscore the benefits and potential of whānau-centred initiatives in enhancing whānau health outcomes, and advocate for continued strengths-based practices in Aotearoa New Zealand's health system. By bridging the gap between academia and grassroots community action, the article demonstrates the potential of whānau-centred initiatives and contributes to a global call for integrating Indigenous viewpoints and practices into Westernized healthcare, in order to improve Indigenous health outcomes.

Waka ama: An exemplar of indigenous health promotion in Aotearoa New Zealand

ISSUE ADDRESSED

The use of old-style, top-down health education and awareness programmes in Aotearoa New Zealand, which adopt a single issue-based approach to health promotion, primarily ignores a broad approach to social determinants of health, as well as indigenous Māori understandings of wellbeing.

METHODS

This paper draws on the indigenous framework Te Pae Māhutonga as a guide for presenting narratives collated from members of a waka ama rōpū (group) who were interviewed about the social, cultural and health benefits of waka ama.

RESULTS

This waka ama case study is an exemplar of community-led health promotion within an indigenous context, where Māori values and practices, such as whanaungatanga (the process of forming and maintaining relationships), manaakitanga (generosity and caring for others) and kaitiakitanga (guardianship), are foundational. The findings highlight the multiple benefits of engagement in waka ama and illustrate effective techniques for enhancing wellbeing within local communities.

CONCLUSION

At a time when Aotearoa New Zealand is seeing a decreasing trend in physical activity levels and an increase in mental health challenges, waka ama provides us with an exemplar of ways to increase health and wellbeing within our communities. SO WHAT?: The findings of this research contribute to the evidence base of effective indigenous health promotion, bridging the gap between academia and local community action. To better recognise, comprehend and improve indigenous health and wellbeing, we argue that active participation of people in the community is required to achieve long-term and revolutionary change.

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.

Canada’s Impact Assessment Act, 2019: Indigenous Peoples, Cultural Sustainability, and Environmental Justice

It is well documented that the colonizers of Canada have long coveted the ancestral homelands of the Canadian Indigenous peoples for settlement and development. With this end goal in mind, it is not surprising that there exists an extensive history of assimilative efforts by the colonizers with respect to the Indigenous peoples of Canada—for example, legal assimilation through enfranchisement (voluntary and involuntary) and blood quantum requirements, and cultural assimilation through residential schools and the “sixties scoop”. Another form of assimilation is environmental assimilation, that is, colonial development on Indigenous homelands to the extent whereby Indigenous cultural activities can no longer be supported in the development-transformed environment. Herein, I examine Bill C-69, a Government of Canada omnibus bill, through an environmental justice lens in the context of development across Canada on Indigenous homelands and impacts on Indigenous cultural sustainability. Specifically, Part 1 (i.e., the Impact Assessment Act, 2019) and Part 3 (i.e., the Canadian Navigable Waters Act, 2019) of Bill C-69 pose significant threats to Indigenous cultural sustainability. Through an environmental justice lens, procedural aspects include the use of the project list and scheduled waterways, the discretionary decision-making powers of the Government of Canada representatives, and the lack of acknowledgement of procedural elements of the environmental assessment processes that are constitutionally protected in comprehensive land claims. While, distributive justice aspects consist of unsustainable development from an Indigenous perspective, whereby environmental costs and benefits have been (and will be) distributed inequitably. Bill C-69 is a flawed statute that reinforces the colonial policy of assimilation.

Factors Influencing Men's Experiences and Engagement with the Rugby Fans in Training-New Zealand Pilot Trial: A Healthy Lifestyle Intervention for Men

Health promotion programs designed specifically to support men to improve their lifestyle behaviours are required to improve men's health. This study explored factors that influenced men's experiences of, and engagement with, the Rugby Fans in Training-New Zealand pilot trial, a professional sport-based healthy lifestyle intervention for overweight men. Thirty-five men (mean age = 45, SD = 10 years) who completed the 12-week intervention participated in one of eight semi-structured focus groups. Using inductive thematic analysis, five themes represented the meanings in the data. First, a group of like-minded men all in the same boat recognised the importance of being in similar life situations and having similar reasons for joining the programme. Second, the men described the importance of the support and motivation provided by the team atmosphere created through the programme. Third, the motivational coach recognised the characteristics, skills and knowledge of the coach delivering the programme which created engagement with it. Fourth, the education sessions were valued for the knowledge gained and underpinning philosophies that guided them. Finally, the involvement of the rugby franchise influenced commitment to the programme and created initial interest. These results provide evidence for the key components that should be incorporated into the future development of and improvement to healthy lifestyle interventions for men.

Green Energy—Green for Whom? A Case Study of the Kabinakagami River Waterpower Project in Northern Canada

Green energy has become a term that heralds efforts of environmental conservation and protection worldwide; however, much of it is marred with questions of what it means to be green. More precisely, it has become a question of Green for whom? While many of the impacts of supposed green energy projects are local in their reach, some may be more regional in their scope, such as hydroelectric power. Hydroelectric power generation negatively impacts the environment and people who rely on the environment for sustenance, such as, Indigenous peoples of northern Canada. Taking into account their position with respect to the areas impacted by these green projects, many Indigenous peoples have voiced their concerns and doubts concerning green energy, which is purported to be a mode of energy production that champions the environment. The Kabinakagami River Waterpower Project serves as a case study for both the potential effects of the project and the different views associated with these endeavors. If nothing else, the accounts and testimonies found within shall stand as a testament to the hubris of calling an energy project green without properly assessing and considering the impacts. While these statements relate to the case presented, they also carry significance in the wider world due to the numerous Indigenous communities around the world that are having their spaces slowly being encroached upon in the name of sustainable growth, or green energy. This will especially be true in the post-COVID-19 period where green energy and a green economy are being touted as a way towards state and worldwide recovery.

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.

Cultural efficacy predicts body satisfaction for Māori

This paper examines the relationship between body mass index (BMI), self-esteem and self-reported confidence and capability in expressing oneself culturally as Māori (cultural efficacy) for 5,470 Māori who participated in Te Rangahau o Te Tuakiri Māori me Ngā Waiaro ā-Pūtea | The Māori Identity and Financial Attitudes Study (MIFAS) in 2017. Adjusting for demographics, self-reported health, education and socio-economic status, we found that a higher BMI was associated with lower body satisfaction and self-esteem. However, higher scores on cultural efficacy were associated with higher levels of body satisfaction and self-esteem for respondents. Furthermore, the negative association between BMI and both body satisfaction and self-esteem was weaker for those with higher cultural efficacy. This held for BMI scores of 25, 30, and 35+. While our data suggest higher cultural efficacy may directly or interactively shield Māori from developing lowered self-esteem typically associated with higher BMI in Western populations, further research, using more comprehensive measures of body satisfaction should explore the extent to which Māori may find the Western "thin ideal" personally desirable for their own bodies.

Health measures of Eeyouch (Cree) who are eligible to participate in the on-the-land Income Security Program in Eeyou Istchee (northern Quebec, Canada)

BACKGROUND

Participation in on-the-land programs that encourage traditional cultural activities may improve health and well-being. The Income Security Program (ISP) - a financial incentive-based on-the-land program - for Eeyouch (Cree) hunters and trappers in Eeyou Istchee was created as a result of the 1975 James Bay and Northern Quebec Agreement to help mitigate the effects of hydroelectric development on the Cree people of northern Quebec, Canada. Beyond the ISP's financial incentives, little is known about the health measures of those who are eligible to participate in the ISP (i.e. spent ≥120 days on-the-land during the previous year). Therefore, this paper's objective was to assess the health measures of northern Quebec Cree, who were eligible for participation in the ISP.

METHODS

Using participant data (n = 545) compiled from the Nituuchischaayihtitaau Aschii Multi-Community Environment-and-Health Study, we assessed 13 different health measures in generalized linear models with the independent variable being the eligibility to participate in the ISP.

RESULTS

Participants in the present study who were eligible for the ISP had significantly higher levels of vigorous and moderate activity per week, and higher concentrations of omega-3 polyunsaturated fatty acids in the blood compared to those ineligible for the ISP (i.e. spent ≤119 days on-the-land during the previous year). Encouragingly, following model adjustment for age and sex, participants eligible for the ISP did not have higher blood concentrations of mercury than those who were not eligible for the ISP.

CONCLUSIONS

Our results suggest that the participants eligible for participation in the ISP are likely to be healthier than those who are ineligible to participate - and are promising for on-the-land programs for Indigenous peoples beyond a financial incentive - with no apparent higher risk of increasing contaminant body burden through traditional on-the-land-activities (e.g. fish consumption).

Harvest Programs in First Nations of Subarctic Canada: The Benefits Go Beyond Addressing Food Security and Environmental Sustainability Issues

By breaking down barriers that impacted the ability of subarctic First Nations people to harvest waterfowl, the Sharing-the-Harvest program provided a safe, nutritious, and culturally appropriate food (i.e., geese) to James Bay Cree communities while also helping to protect the environment by harvesting overabundant geese. However, the impacts extend beyond those described above. Thus, the objectives of the present paper are twofold: to document the food sharing networks of the Sharing-the-Harvest program; and to examine the benefits associated with the harvest program beyond food security and environmental sustainability issues, as revealed through semi-directed interviews. In the regional initiative, harvested geese were shared with all James Bay communities; sharing is an important part of Cree culture. Where detailed information was collected, the goose-sharing network reached 76% of the homes in one of the communities. Likewise, in the local initiative, the goose-sharing network had a 76% coverage rate of the homes in the community. Although decreasing food insecurity was an important focus of the harvest-sharing programs, there were other benefits, from an Indigenous perspective, of being on the land, as identified by the Cree harvesters through semi-directed interviews (e.g., the transmission of Indigenous knowledge, the strengthening of social networks, and the feeling of wellness while out on-the-land). Thus, by participating in the on-the-land harvest programs, the Cree gained benefits beyond those solely related to strengthening food security and contributing in part to environmental sustainability. The Sharing-the-Harvest protocol has the potential to be adapted and employed by other Indigenous (or marginalized) groups worldwide, to help improve health and wellness, while, also protecting the environment from overabundant and/or invasive species.

Becoming active: more to exercise than weight loss for indigenous men

Objective: To understand what motivates sedentary indigenous and ethnic minority men to become more physically active. Design: We use thematic analysis to present data from a qualitative study exploring 23 sedentary indigenous Māori (New Zealand) men's experiences of completing a 12-week exercise intervention to improve their metabolic health. Results: Four themes emerged: The Bros - having fellowship and mutual motivation; Being better informed about exercise; Impacting overall wellbeing; and Disseminating the findings beyond the study Exercise interventions informed by indigenous Māori cultural values and knowledge increased its relevance to their daily lives. The motivation for these indigenous men was more culturally-based external factors than an inherent desire to lose weight. Conclusion: Indigenous and minority men in many developed countries have high morbidity and premature mortality related to sedentary lifestyles. The low uptake of physical activities possibly relates to focusing more on outcomes such as weight loss which lacks cultural relevance. When offering health promotion interventions for marginalized populations these findings highlight the importance of culturally tailoring interventions to the unique sources of motivation for each group to increase activity to improve their efficacy.

A case study of using the He Pikinga Waiora Implementation Framework: challenges and successes in implementing a twelve-week lifestyle intervention to reduce weight in Māori men at risk of diabetes, cardiovascular disease and obesity

Background

Māori men have stark health inequities around non-communicable diseases. This study describes the case of a partnership attempting to develop and implement a culturally centred intervention through a collaborative partnership to potentially address the inequities. In particular, the partnership followed a participatory, co-design approach using the He Pikinga Waiora (HPW) Implementation Framework; the study presents lessons learnt in addressing health inequities following this framework.

Methods

The partnership involved a university research team and a Māori community health provider. They engaged with other stakeholders and several cohorts of Māori men through a co-design process to adapt a 12-week lifestyle intervention. The co-design process was documented through meeting notes and interviews with partners. Two cohorts participated in separate single group pre-intervention/post-intervention designs with multi-method data collection. Key outcome measures included weight loss, self-reported health, physical activity, and nutrition. Post-intervention data collection included qualitative data.

Results

The co-design process resulted in a strong and engaged partnership between the university team and the provider. There were significant challenges in implementing the intervention including having two additional partner organisations dropping out of the partnership just after the initial implementation phase. However, a flexible and adaptable partnership resulted in developing two distinct lifestyle interventions run with 32 Māori men (in two different cohorts of 8 and 24). All but one in the first cohort completed the programme. The first cohort had a modest although statistically insignificant improvement in weight loss (d = 1.04) and body mass index (BMI; d = 1.08). The second cohort had a significant reduction in weight loss (d = 1.16) and BMI (d = 1.15). They also had a significant increase in health-related quality of life (d = 1.7) and self-rated health (d = 2.0).

Conclusion

The HPW Framework appears to be well suited to advance implementation science for Indigenous communities in general and Māori in particular. The framework has promise as a policy and planning tool to evaluate and design interventions for chronic disease prevention in Indigenous communities. Despite this promise, there are structural challenges in developing and implementing interventions to address health inequities.

Trial registration

Retrospectively registered, Australia New Zealand Clinical Trials Registry, ACTRN12619001783112.

Ngātiwai Whakapakari Tinana: strengthening bodies through a Kaupapa Māori fitness and exercise programme

INTRODUCTION Activity based weight loss programmes may result in modest reductions in weight. Despite the small successes demonstrated by these interventions, there are few examples that specifically address the disparity of obesity for Māori compared to non-Māori. AIM This research highlights the results of a Kaupapa Māori fitness and exercise programme that aimed to assist mainly Māori adults, to lose weight. The programme was designed to support participants by using Māori cultural values. METHODS A Muay Thai kickboxing exercise programme was developed with community involvement. Kaupapa Māori principles underpinned the programme, such as whanaungatanga and tino rangatiratanga. Ninety-three participants were followed for at least 3 months. Participants' blood pressure, weight, body mass index, mental wellbeing scores, and waist and hip circumferences were collected at regular intervals. Multiple linear models were used to calculate estimated changes per 100 days of the programme. RESULTS The mean duration of participation was 214 days. The estimated weight loss per participant per 100 days was 5.2 kg. Statistically significant improvements were noted in blood pressure, waist and hip circumference, systolic blood pressure and mental wellbeing. DISCUSSION The improvements in physical and mental wellbeing are thought to have stemmed, in part, from the use of Kaupapa Māori principles. The success of this programme strengthens the argument that programmes aiming to address the precursors of chronic disease need to be designed for Māori by Māori in order to reduce health inequities.

Reported Māori consumer experiences of health systems and programs in qualitative research: a systematic review with meta-synthesis

BACKGROUND

Persistent inequities in health experiences and outcomes are observed for Māori compared to non-Māori in Aotearoa New Zealand. We conceptualised factors associated with Māori consumer experiences of health programs and services and characterise how the recommendations arising from qualitative research inform strategies to address inequities.

METHODS

In this systematic review, electronic literature searching was conducted in February 2018. Qualitative studies reporting Māori consumer experiences of health services and programs in Aotearoa New Zealand were eligible. Māori consumer experiences of health services were mapped to the WHO Commission of Social Determinants of Health (CSDH) conceptual framework on health inequities as related to: (i) the socioeconomic and political context; (ii) socioeconomic positioning; or (iii) intermediary factors that increase exposure to health-compromising conditions. Recommendations to improve consumer experiences were mapped to the CSDH framework for tackling social determinants of health inequities as policy directions on: (i) unequal consequences of illness (individual interaction); (ii) risks of exposure to health-damaging factors (community); (iii) exposures to health-damaging factors (public policies); and (iv) mitigating effects of socioeconomic and political stratification (environment).

RESULTS

Fifty-four studies were included. Māori consumer experiences mapped to social determinants of health inequities were most frequently related to direct interactions with health services and programs, particularly patient-clinician interactions (communication, relationships) and cultural competencies of clinicians and the system. Key recommendations by researchers mapped to potential strategies to address inequity were identified at all levels of the political, social and health system from individual interactions, community change, and broader public and system-level strategies. Recommendations were predominantly focused on actions to reduce risks of exposure to health-damaging factors including health literacy interventions, increased resources in cultural competencies and Māori capacity in health service development and workforce.

CONCLUSIONS

Māori consumer experiences of health services and programs are an important informer of variables that impact health inequity. Strategies to tackle health inequities informed by Māori consumer experiences can be drawn from existing empirical research. Future qualitative exploration of how socioeconomic, political and public policies influence Māori consumer experiences of health services and programs could inform a broader range of structural policies to address health inequities.

Effect of Gender and Physical Activity on Internet Addiction in Medical Students

Objective:

To determine the effect of gender and physical activity on internet addiction in medical students.

Methods:

In this cross sectional, analytical study Young’s internet addiction test questionnaire was distributed to 350 MBBS students of Army Medical College, Rawalpindi. The study was conducted from January to May 2015. A dichotomous response from students regarding physical activity was obtained which was verified from the sports department of the institution. Based upon total score, internet addiction was categorized as no addiction if the score was less than or equal to 49, moderate addiction when the score was 50 to 79 and severe when the score was 80 to 100.

Results:

Out of 322 respondents 175 (54.3%) were males and 147 (42.7%) females with a mean age of 19.27±1.01 years. Total internet addiction score and frequency of internet addiction were similar between males and females (37.71±11.9 vs 38.63±14.00, p=0.18 and 25 vs 29, p=0.20). However, total score and frequency of internet addiction were higher in students lacking physical activity as compared to those with regular physical activity (40.37±15.05 vs 36.38±11.76, p=0.01 and 30 vs 24, p=0.01).

Conclusion:

Internet addiction is unrelated to gender however it is inversely related to physical activity.