Course:KIN366/ConceptLibrary/Aboriginal Children Physical Activity Interventions

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Movement Experiences for Young Children
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KIN 366
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Instructor: Dr. Shannon Bredin
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A physical activity intervention is a program that promotes overall health and wellness by increasing physical activity levels in a specific population. Over the past several decades in Canada, a dramatic increase in the rates of childhood obesity and type 2 diabetes has been reported (Tremblay et al., 2002; Warburton et al., 2009). Amongst Aboriginal children, defined as those of First Nations, Métis or Inuit descent, these rates have found to be even higher (Ng, et al., 2006; Young et al., 2000; Hanley et al., 2000; Willows et al., 2005). This discrepancy has prompted a call for intervention from researchers on the behalf of Aboriginal communities (Willows et al., 2012; Hanley et al., 2007; Anand et al., 2007;Young et al., 2000; Warburton et al., 2009). Physical activity, which can be defined as any bodily movement produced by skeletal muscles that results in energy expenditure, along with dietary and behavioral modifications have been used to address these growing rates of chronic diseases within Aboriginal communities with varying degrees of success (Paradis et al., 2005; Anand et al., 2007). Further research is needed to determine how to increase the current accomplishments of physical activity interventions with a particular focus on helping Aboriginal children make permanent, healthy lifestyle choices.

Common Characteristics of Children Intervention Programs

Recent evidence has shown that the most effective physical activity interventions take a multi-faceted approach (Shaw et al., 2005). This includes using behavioral strategies and offering dietary counselling as well as providing opportunities for physical activity. Many physical activity interventions for Aboriginal children have taken this three-pronged approach(Anand et al., 2007; Saksvig et al., 2005). Typical assessments taken during physical activity interventions include physical activity levels, nutrient intake and knowledge about healthy eating practices. Physical measurements such as body mass index, waist circumference, blood pressure, fasting glucose levels and physical fitness are commonly evaluated as well.

Trends in the Data from Physical Activity Interventions

Previous physical activity interventions for Aboriginal children have seen minimal short-term success however there seems to be little supporting evidence of long-term maintenance of healthy lifestyle choices. The most commonly reported benefit from physical activity interventions was an increase in the knowledge of a healthy diet and positive changes made to participant’s diets (Anand et al., 2007;Tomlin et al., 2012;Paradis et al., 2005). Multiple studies reported an increase in the consumption of fruits and vegetables and some also reported a decrease in consumption of processed foods (Tomlin et al., 2012; Saksvig et al., 2005;Paradis et al., 2005; Anand et al, 2007). Changes in physical activity during interventions, however, were found to be inconsistent. Some studies found levels of physical activity to increase during the intervention program, while others failed to see a change (Anand et al, 2007; Paradis et al., 2005). A few studies did report an increase in the level of physical fitness for children (Anand et al, 2007, Saksvig et al., Tomlin et al., 2012). However, long term follow up reveal increases in physical activity levels were not maintained. Many of the studies also found that chronic disease risk factors, such as large waist circumference and high body mass index, remained unchanged with these interventions (Paradis et al., 2005, Anand et al, 2007).

Statistics of Canadian Aboriginal Children

Canadian Aboriginals have a population of 1, 172, 785, approximately 3.7% of Canada’s total population (Statistics Canada, 2006). However their projected annual growth rate is more then double than the expected growth for the entire Canadian population (Statistics Canada, 2005). Approximately half of the Aboriginal population (48%) are under the age of 24 and there are almost twice as many Canadian Aboriginal children as non- Aboriginal children (Statistics Canada, 2006). Canadian Aboriginal children are at a higher risk for developing type 2 diabetes in childhood and exhibiting physical measurements that are associated with increased health risks in adulthood (Young et al, 2000; Ng, et al., 2006). For example, both Canadian Aboriginal children living on and off reserves exhibited much higher levels of obesity then non- Aboriginal children, which puts them at an increased risk for cardiovascular disease. The Canadian Community Healthy Survey (2004) reported that Aboriginal children living off reserves had an obesity incidence level of 20%, which was two and a half times the Canadian national average (Hanna, 2009). Other surveys have shown children living on reserve to have an obesity prevalence ranging from 25%-38% (First Nations Regional Longitudinal Health Survey, 2003; Kaler et al., 2006). Alarmingly, these rates are continuing to rise. The prevalence of type 2 diabetes amongst Canadian Aboriginal children has been reported as high as 4% in some communities and girls are more at higher risk then boys (Young et al., 2000; Bloomgarden, 2004). The data on physical activity levels of Aboriginal children is not well known (Foulds et al., 2013). A recent review conducted by Foulds and colleagues (2013) found that only 26.5- 45% of Aboriginal children within Canada and the United States met government physical activity recommendations. In a study conducted in a Northern Quebec Aboriginal community, 50% of children were found to meet physical activity recommendations, however their levels of physical fitness were very poor (Ng et al., 2006).

History of Chronic Diseases amongst Aboriginal Populations

Historically, Aboriginal Canadians exhibited high levels of physical activity in their traditional hunter-gather lifestyle and had very low rates of chronic diseases such as obesity, cardiovascular disease and diabetes (Bloomgarden, 2004;Foulds et al., 2011). However, a dramatic shift in the cultural, economic and social norms over the past several decades has led to rapid and alarming increases in chronic diseases amongst Aboriginals (Liu, 2006). The causal relationship for the development of these chronic conditions is multi-factorial and complex but Willows and colleagues (2012) cite the historical colonization and assimilation of the Aboriginal peoples as a major contributing factor. Reserves are only a fraction of the original territories Aboriginal people lived on, which greatly limits the accessibility of traditional foods (Willows et al., 2012). Instead of being self-sufficient, Aboriginal communities are reliant on others for food sources. This shift away from a traditional hunter- gather lifestyle has also had the effect of decreasing the levels of physical activity in Aboriginal populations.

Benefits of Physical Activity Interventions

Physical activity interventions have the potential to be very beneficial for the health and wellness of Aboriginal children. There is an overwhelming amount of evidence that shows regular physical activity is very important for prevention and maintenance of chronic conditions such as cardiovascular disease, obesity, cancer and osteoporosis as well as reducing the risk of premature death (Warburton et al., 2006). Warburton and colleagues (2006) reported a linear graded relationship between the volume of physical activity and health status. Individuals who engage in the lowest amount of activity have the poorest health, but they also experience the most health benefits when they start to engage in exercise, which has important implications for physical activity interventions.Aboriginal children whom have been shown to have low levels of physical activity and high prevalence of chronic disease should benefit from appropriate physical activity interventions, however further research is needed to determine how to implement a successful intervention program. Physical activity is not only linked to physical health but also mental health. Individuals who engage in regular physical activity suffer from less depression, and anxiety (Warburton et al., 2001). They also demonstrate improved self-esteem and better coping mechanisms of dealing with stress (Fox, 1999; Norris et al., 1992; Salmon, 2001). Physical activity interventions also have the potential to benefit Aboriginal children from a social perspective. Sports and other physical activities can foster relationships and help bring communities together.Including elders in the intervention programs as leaders helps bridge the gap between generations, facilitates sharing of knowledge and gives children appropriate role models (Hanna, 2009). Physical activity interventions can also incorporate traditional activities, such as pow wow dancing, lacrosse or hunting, thereby enhancing children’s cultural experiences as well as being physically active.

Barriers to Physical Activity Interventions

There are a number of barriers that prevent physical activity intervention aimed at Aboriginal children from being successful. Many of these barriers are structural in nature and arise from the fact that numerous Aboriginal reserves are quite isolated. For example, fresh fruit and vegetables may be limited and expensive, making it difficult for families to consistently eat healthy. Depending on the region, reserves may also not have the necessary resources to make traditional foods (Willows et al., 2012). Another example of a common barrier is a distinct lack of sidewalks or bike lanes on the reserve which prevent children from being able to use active transport to school or their extracurricular activities (Anand et al., 2007). The environment is an important consideration as well. Many of the northern communities face adverse weather conditions that limit outdoor physical activities and ability to safely travel. In a survey conducted by First Nations Health Society, many of the reasons children gave for not participating in physical activity fell under the category of a lack of resources,whether it be programs, venues, coaches, equipment or transportation (Hanna, 2009). Numerous communities do not have their own fitness facilities and it is expensive to rent out space. Compounding this difficulty is the low socioeconomic status of many Aboriginal families (Willows et al., 2012). Unfortunately, 42% of Aboriginal children under age of 14 do not live with both parents which places limits on time and resources for the children (Statistic Canada, 2006). Even when after school programs are free, parents often found it too inconvenient or were unable to drive their children to the program(Anand et al., 2007). Individuals have to be highly motivated to overcome these barriers, and in many instances, participants were unable to do so (Anand et al., 2007). Besides structural barriers, there are numerous social, cultural and political barriers beyond the control of the program that make lifestyle modifications difficult to achieve over the short term (Paradis et al., 2005). Each community has a unique set of barriers that must be identified and addressed before effective physical interventions will occur.

Future Research

There have been a limited number of interventions for Canadian Aboriginal children and more research needs to be conducted on how to most effectively intervene in a culturally appropriate manner. Obtaining knowledge regarding the importance of being physically active does not seem to be enough to motivate individuals to make permanent lifestyle modifications (Anand et al., 2007). Innovative programs are needed to find unique solutions on how to improve health and physical activity levels over the long term as well as the short term. Despite increases in knowledge of the prevalence of chronic disease in Aboriginal children, the amount of physical activity Aboriginal children engage in is relatively unknown (Foulds et al., 2013). Taking this a step further, research not only needs to look at the amount of physical activity but also the intensity of the activity (Anand et al., 2007). It may be that children engage in enough physical activity to meet recommendations for time, but fail to exercise at a high intensity. Physical activity not only encompasses sport and exercise, but any activity that results in movement such as domestic care, occupational duties and cultural traditions. The use of culturally based forms of physical activity,along with contemporary sports and activities,may be a critical component of implementing physical activity interventions in Aboriginal communities but further research is needed to confirm this.

Recommendations

  • In Aboriginal culture, the community is extremely important. Before implementing any physical activity intervention, consultation with the community and in particular receiving the elders’ input is essential (Martin- Hill and Saucy, 2005). In order for a program aimed at Aboriginal children to be successful, it must have the community and parental support.
  • Oftentimes, training members of the community to implement the physical activity with minimal academic involvement is more effective then bringing outsiders in. This also serves to provide a relatable role model for the children.
  • Each community has unique barriers that must be recognized and addressed. Physical activity interventions need to be tailored to meet the needs of the community.
  • Focus on total activity time as opposed to leisure time activity which may be less useful for Aboriginal populations (Young and Katzmarzyk, 2007). This is because many Aboriginal communities have limited resources available and cultural activitie smay not fit into the leisure category.
  • Essential to any program for children is to make it fun! The more enjoyable children find physical activity, the more likely they will want to participate and have positive associations with physical activity.

References

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Public Health Nutrition, 2(3a), 411-418. Hanley, A. J., Harris, S. B., Gittelsohn, J., Wolever, T. M., Saksvig, B., & Zinman, B. (2000). Overweight among children and adolescents in a Native Canadian community: prevalence and associated factors. The American journal of Clinical Nutrition, 71(3), 693-700 Hanna, R. (2009). Promoting, developing, and sustaining sports, recreation, and physical activity in British Columbia for Aboriginal youth. Retrieved from http://www.fnha.ca/documents/sports_recreation_and_physical_activity_bc__aboriginal_youth.pdf Kaler, S. N., Ralph-Campbell, K., Pohar, S., King, M., Laboucan, C. R., & Toth, E. L. (2006). High rates of the metabolic syndrome in a First Nations Community in western Canada: prevalence and determinants in adults and children. International Journal of Circumpolar Health,65(5), 389- 402. Katzmarzyk, P. T. (2008). Obesity and physical activity among Aboriginal Canadians. Obesity, 16(1), 184-190. Martin-Hill, D., and D. Soucy. (2005). Ganono'se'n e yo'gwilode' - Ethical Guidelines for Aboriginal Research Elders and Healers Roundtable. Retrieved from http://ahrnets.ca/files/2010/05/Ethical-Guidelines-for-Aboriginal-ResearchFinalReport2005.pdf Norris, R., Carroll, D., & Cochrane, R. (1992). The effects of physical activity and exercise training on psychological stress and well-being in an adolescent population. Journal of Psychosomatic Research, 36(1), 55-65. Ng, C., Marshall, D., & Willows, N. D. (2006). Obesity, adiposity, physical fitness and activity levels in Cree children. International Journal of Circumpolar Health,65(4). Paradis, G., Lévesque, L., Macaulay, A. C., Cargo, M., McComber, A., Kirby, R., ... & Potvin, L. (2005). Impact of a diabetes prevention program on body size, physical activity, and diet among Kanien'kehá: ka (Mohawk) children 6 to 11 years old: 8-year results from the Kahnawake Schools Diabetes Prevention Project. Pediatrics,115(2), 333-339. Tomlin, D., Naylor, P. 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Aboriginal Peoples in Canada in 2006: Inuit, Metis and First Nations, 2006 Census. Retrieved from www.statcan.ca Warburton, D. E., Gledhill, N., & Quinney, A. (2001). Musculoskeletal fitness and health. Canadian journal of applied physiology, 26(2), 217-237. Warburton, D. E., Nicol, C. W., & Bredin, S. S. (2006). Prescribing exercise as preventive therapy. Canadian Medical Association Journal, 174(7), 961-974. Warburton, D. E., Foulds, H. J., Charlesworth, S., Rhodes, R. E., & Bredin, S. S. (2009). The importance of physical activity interventions in Aboriginal children. The Health & Fitness Journal of Canada,1(1), 9-13. Willows, N.D. (2005). Overweight on Aboriginal children: Prevalence, implications and solutions. Journal of Aboriginal Health, 2. 76-85 Willows, N. D., Hanley, A. J., & Delormier, T. (2012). A socioecological framework to understand weight-related issues in Aboriginal children in Canada.Applied Physiology, Nutrition, and Metabolism, 37(1), 1-13. Young, T. 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