The effectiveness of community based physical activity interventions with Aboriginal peoples

Indigenizing Cardiac Rehabilitation: The Role for Cultural Adaptation

Cardiac rehabilitation (CR) is an integral component of cardiovascular care, which reduces morbidity and mortality, and improves quality of life. Largely as a result of Canada's colonial history, Indigenous communities face higher rates of cardiovascular morbidity and mortality. Indigenous Peoples in Canada have a unique cultural, historical, and geographic context that limits access to high-quality cardiovascular care, including CR, which has traditionally been delivered in an urban, hospital-based setting. Culturally adapted, holistic exercise and diet programs and CR programs have been successful in Canada, Australia, and New Zealand, demonstrating acceptability to the community, safety, and improvements in cardiovascular risk factors. Key components of a successful culturally adapted CR program include program leadership and development by Indigenous community members and key partners, cultural sensitivity training for health care providers and financial and geographic accessibility. Encouragement of traditional practices, including healthy traditional dietary practices, and recognizing land-based activities as exercise have also proved important in the successful delivery of CR in Indigenous communities. This review summarizes the current evidence for culturally adapted CR programming for Indigenous patients, including strategies to engage communities in education on cardiovascular risk-factor optimization and to promote guideline-based exercise and diet through an Indigenous lens.

Cardiovascular Disease Risk Factor Interventions in Women With Prior Gestational Hypertensive Disorders or Diabetes in North America: A Rapid Review

Women with previous hypertensive disorders of pregnancy (HDP) or gestational diabetes mellitus (GDM) have a 2- to 3-fold increased risk of cardiovascular disease (CVD). The goal of this rapid review was to summarize evidence of the effectiveness of CVD risk factor interventions for postpartum women with a history of HDP or GDM. A comprehensive search strategy was used to search articles published in 5 databases-Ovid MEDLINE, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Embase). Observational and intervention studies that identified CVD prevention, screening, and/or risk factor management interventions among postpartum women with prior HDP or GDM in Canada and the US were included. The quality of observational and interventional studies, and their risk of bias, were assessed using appropriate critical appraisal checklists. Eight studies, including 4 observational cohorts, 3 randomized controlled trials, and 1 quasi-experimental study, merited inclusion for analysis. A total of 2449 participants were involved in the included studies. The most effective CVD risk factor intervention was comprised of postpartum transition and follow-up, CVD risk factor education, and advice on lifestyle changes. Most of the observational studies led to improvements in CVD risk factors, including improvements in CVD lifetime risk scores. However, none of the RCTs led to improvements in cardiometabolic risk factors. Few studies have investigated CVD risk factor interventions in the postpartum in women with previous HDP or GDM in North America. Further studies of higher quality are needed.

Indigenous Land-Based Approaches to Well-Being: The Niska (Goose) Harvesting Program in Subarctic Ontario, Canada

Historically, goose harvesting provided a source of culturally significant, safe, and nutritious food for the Omushkego Cree of subarctic Ontario, Canada. Disruptions stemming from colonization and climate change have led to a decrease in harvesting, resulting in higher rates of food insecurity. The aim of the Niska program was to reconnect Elders and youth to revitalize goose harvesting activities and associated Indigenous knowledge within the community. The program and evaluation were built using a two-eyed seeing (Etuaptmumk) and community-based participatory research approach. Salivary cortisol, a biomedical measure of stress, was collected before (n = 13) and after (n = 13) participation in the spring harvest. Likewise, cortisol samples were collected before (n = 12) and after (n = 12) the summer harvest. Photovoice and semi-directed interviews were employed after the spring (n = 13) and summer (n = 12) harvests to identify key elements of well-being from an Indigenous perspective. The changes observed in cortisol levels for the spring (p = 0.782) and summer (p = 0.395) harvests were not statistically significant. However, there was a noteworthy increase in the subjective well-being observed through the qualitative measures (semi-directed interviews and photovoice), highlighting the importance of using multiple perspectives when assessing well-being, especially in Indigenous peoples. Future programs should incorporate multiple perspectives when addressing complex environmental and health issues, such as food security and environmental conservation, especially in Indigenous homelands worldwide.

Linking Heart Health and Mental Wellbeing: Centering Indigenous Perspectives from across Canada

Indigenous peoples have thrived since time immemorial across North America; however, over the past three to four generations there has been a marked increase in health disparities amongst Indigenous peoples versus the general population. Heart disease and mental health issues have been well documented and appear to be interrelated within Indigenous peoples across Canada. However, Western medicine has yet to clearly identify the reasons for the increased prevalence of heart disease and mental health issues and their relationship. In this narrative review, we discuss how Indigenous perspectives of health and wholistic wellness may provide greater insight into the connection between heart disease and mental wellbeing within Indigenous peoples and communities across Canada. We argue that colonization (and its institutions, such as the Indian Residential School system) and a failure to include or acknowledge traditional Indigenous health and wellness practices and beliefs within Western medicine have accelerated these health disparities within Indigenous peoples. We summarize some of the many Indigenous cultural perspectives and wholistic approaches to heart health and mental wellbeing. Lastly, we provide recommendations that support and wholistic perspective and Indigenous peoples on their journey of heart health and mental wellbeing.

Physical Activity Interventions Among American Indian and Alaska Native Persons: A Systematic Review

OBJECTIVE

The purpose of this review was to identify and describe physical activity (PA) interventions that have been implemented with American Indian and Alaska Natives (AIANs) in the U.S. and Canada since 2006.

DATA SOURCE

Searches were conducted in 8 databases plus grey literature sources.

STUDY INCLUSION AND EXCLUSION CRITERIA

Eligible studies: (a) described an intervention designed to increase PA; (b) targeted AIANs residing in the U.S. or Canada, or if a multiethnic population, contained an AIAN subanalysis; (c) were published in 2006 or later; and (d) reported a PA outcome.

DATA EXTRACTION

Two reviewers independently extracted data, with conflicts resolved through discussion.

DATA SYNTHESIS

Data were synthesized by participant characteristics, intervention strategies, PA outcomes, and impact.

RESULTS

We identified 25 eligible studies, most targeting children and youth. Intergenerational, environmental policy, cultural adaptation, and curriculum-based approaches were used. Twenty studies used self-reported PA measures. 80% of studies used an element of cultural adaptation, mostly considering cultural needs in design, not program or outcome evaluation. Sedentary behavior and leisure-time PA were rarely assessed. Significant changes in PA outcomes were achieved post-intervention in 13 studies (52%).

CONCLUSION

Future interventions should target AIAN adults to evaluate sedentary behavior and leisure-time PA. Interventions should incorporate psychometrically tested objective measures and prioritize the Native perspective from intervention design through project evaluation.

Outcomes reported in evaluations of programs designed to improve health in Indigenous people

OBJECTIVE

To assess the outcomes reported and measured in evaluations of complex health interventions in Indigenous communities.

DATA SOURCES

We searched all publications indexed in MEDLINE, PreMEDLINE, EMBASE, PsycINFO, EconLit, and CINAHL until January 2020 and reference lists from included papers were hand-searched for additional articles.

STUDY DESIGN

Systematic review.

DATA COLLECTION/EXTRACTION METHODS

We included all primary studies, published in peer-reviewed journals, where the main objective was to evaluate a complex health intervention developed specifically for an Indigenous community residing in a high-income country. Only studies published in English were included. Quantitative and qualitative data were extracted and summarized.

PRINCIPAL FINDINGS

Of the 3523 publications retrieved, 62 evaluation studies were included from Australia, the United States, Canada, and New Zealand. Most studies involved less than 100 participants and were mainly adults. We identified outcomes across 13 domains: clinical, behavioral, process-related, economic, quality of life, knowledge/awareness, social, empowerment, access, environmental, attitude, trust, and community. Evaluations using quantitative methods primarily measured outcomes from the clinical and behavioral domains, while the outcomes reported in the qualitative studies were mostly from the process-related and empowerment domains.

CONCLUSION

The outcomes from qualitative evaluations, which better reflect the impact of the intervention on participant health, remain different from the outcomes routinely measured in quantitative evaluations. Measuring the outcomes from qualitative evaluations alongside outcomes from quantitative evaluations could result in more relevant evaluations to inform decision making in Indigenous health.

An Evolving Model of Best Practice in a Community Physical Activity Program: A Case Study of "Active Herts"

BACKGROUND

Community-based physical activity programs typically evolve to respond to local conditions and feedback from stakeholders. Process evaluations are essential for capturing how programs are implemented, yet often fail to capture delivery evolution over time, meaning missed opportunities for capturing lessons learned.

METHODS

This research paper reports on a staged approach to a process evaluation undertaken within a community-based UK 12-month physical activity program that aimed to capture change and adaptation to program implementation. Twenty-five one-to-one interviews and 12 focus groups took place over the 3 years of program delivery. Participants included program participants, management, and service deliverers.

RESULTS

Program adaptations that were captured through the ongoing process evaluation included changes to the design of promotional material, program delivery content, ongoing training in behavior change, and the addition of regular participant community events. The authors address how these strands evolved over program delivery, and how the process evaluation was able to capture them.

CONCLUSION

The pragmatic evaluation approach enabled changes in response to the local context, as well as improvements in the program to be captured in a timely manner, allowing the delivery to be responsive and the evaluation flexible.

The Impact of Land-Based Physical Activity Interventions on Self-Reported Health and Well-Being of Indigenous Adults: A Systematic Review

For many Indigenous communities, decreased participation in traditional land-based activities has led to higher rates of chronic disease and a decrease in well-being. This systematic review explores how traditional land-based activities impact self-reported health and well-being of Indigenous adults, using Indigenous and Western perspectives. A search of three electronic databases (PubMed, Scopus, and Web of Science) identified nine studies which explored the experiences and perspectives of Indigenous adults taking part in land-based subsistence and ceremonial activities. A thematic analysis of these studies identified many interconnected physical, spiritual, mental, emotional, and community benefits. Community engagement throughout all stages of the interventions was an important factor in effectively addressing challenges and barriers stemming from colonization, decreased knowledge transfer, and increased use of technology. Participants reported developing more effective stress management techniques, a greater awareness of modifiable risk factors along with increased engagement with Elders. Ultimately, land-based subsistence and ceremonial activities were identified as playing an influential role in the lives of Indigenous adults. The involvement of community members allowed for the development of more culturally relevant interventions. Future community-specific research is needed to increase engagement in traditional physical-activities, improve well-being and overall reduce the risk of chronic disease.

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).

Primary Prevention of Cardiovascular Disease in Minority Indigenous Populations: A Systematic Review

INTRODUCTION

Cardiovascular disease (CVD) is the commonest cause of death across the globe; incidence and prevalence rates are increasing. Together, CVD and diabetes mellitus are responsible for a quarter of the health gap observed between Aboriginal Australians and Torres Strait Islanders, and non-Indigenous Australians. Numerous programs have been proposed and implemented to Close the Gap; ideally, these should be evidence-based.

OBJECTIVE

The aim of this review is to evaluate primary prevention measures and programs that aim to reduce CVD risk in minority Indigenous populations around the world.

METHODS

A search of PubMed, the Cochrane Library and the Elsevier Scopus Database was initially conducted using the terms "cardiovascular disease", "population groups", "primary prevention", "health services, indigenous", "indigenous health", "risk assessment" and "risk management". Results were then assessed per inclusion/exclusion criteria. A second reviewer independently evaluated the publications and review process to ensure agreement.

RESULTS

The initial search produced 37 publications; 19 met the inclusion criteria and were incorporated into a comparative table. Most were descriptive, mixed-methods, audit or intervention studies. Heterogeneity of study design prevented statistical analysis.

CONCLUSION

Addressing CVD risk in minority Indigenous populations is a multifactorial challenge; there is substantial room for improvement in routine risk assessment and management. Holistic approaches need to embrace local cultural perceptions of health and wellbeing. Validated risk reduction tools, individualised management plans, polypills and computer based decision support tools are promising to improve outcomes for those at risk.

Health Benefits of Physical Activity: A Strengths-Based Approach

Our special series on Cardiac Rehabilitation outlined the importance of routine physical activity and/or exercise participation in the primary and secondary prevention of cardiovascular disease and many other chronic medical conditions. The evidence is overwhelming, demonstrating that nearly everyone can benefit from becoming more physically active. This messaging has been widely disseminated at regional, national, and international levels. Often, this messaging highlights a physical inactivity crisis and the health perils of not engaging in sufficient amounts of physical activity. This deficits-based messaging often includes generic threshold-based recommendations stating that health benefits can only be accrued with specific volumes or intensities of physical activity. In this Editorial, we argue that the current generic and deficits-based messaging misses a great opportunity to focus on the positive and to facilitate hope and real change at the individual, community, and population levels. We advocate a strengths-based approach to health and wellness promotion that focuses on the innate strengths of individuals, families, and communities to enable self-empowerment and self-determination related to health and wellness. By taking a strengths-based approach, we can build hope, promoting the positive aspects of routine physical activity and exercise participation and providing a greater opportunity to enhance health and wellbeing for everyone.

Barriers and facilitators to the implementation of brief interventions targeting smoking, nutrition, and physical activity for indigenous populations: a narrative review

Objective

This narrative review aimed to identify and categorize the barriers and facilitators to the provision of brief intervention and behavioral change programs that target several risk behaviors among the Indigenous populations of Australia, Canada, and New Zealand.

Methods

A systematic database search was conducted of six databases including PubMeD, Embase, CINAHL, HealthStar, PsycINFO, and Web of Science. Thematic analysis was utilized to analyze qualitative data extracted from the included studies, and a narrative approach was employed to synthesize the common themes that emerged. The quality of studies was assessed in accordance with the Joanna Briggs Institute’s guidelines and using the software SUMARI – The System for the Unified Management, Assessment and Review of Information.

Results

Nine studies were included. The studies were classified at three intervention levels: (1) individual-based brief interventions, (2) family-based interventions, and (3) community-based-interventions. Across the studies, selection of the intervention level was associated with Indigenous priorities and preferences, and approaches with Indigenous collaboration were supported. Barriers and facilitators were grouped under four major categories representing the common themes: (1) characteristics of design, development, and delivery, (2) patient/provider relationship, (3) environmental factors, and (4) organizational capacity and workplace-related factors. Several sub-themes also emerged under the above-mentioned categories including level of intervention, Indigenous leadership and participation, cultural appropriateness, social and economic barriers, and design elements.

Conclusion

To improve the effectiveness of multiple health behavior change interventions among Indigenous populations, collaborative approaches that target different intervention levels are beneficial. Further research to bridge the knowledge gap in this topic will help to improve the quality of preventive health strategies to achieve better outcomes at all levels, and will improve intervention implementation from development and delivery fidelity, to acceptability and sustainability.

"With Every Step, We Grow Stronger": The Cardiometabolic Benefits of an Indigenous-Led and Community-Based Healthy Lifestyle Intervention

Community-based and Indigenous-led health and wellness approaches have been widely advocated for Indigenous peoples. However, remarkably few Indigenous designed and led interventions exist within the field. The purpose of this study was to evaluate an Indigenous-led and community-based health and wellness intervention in a remote and rural Indigenous community. This protocol was designed by and for Indigenous peoples based on the aspirations of the community (established through sharing circles). A total of 15 participants completed a 13-week walking and healthy lifestyle counselling program (incorporating motivational interviewing) to enhance cardiometabolic health. Measures of moderate-to-vigorous physical activity (MVPA; 7-day accelerometry and self-report), predicted maximal aerobic power (VO₂max; 6-min walk test), resting heart rate and blood pressure, and other health-related physical fitness measures (musculoskeletal fitness and body composition) were taken before and after the intervention. The intervention led to significant (p < 0.05) improvements in VO₂max (7.1 ± 6.3 % change), with the greatest improvements observed among individuals with lower baseline VO₂max (p < 0.05, r = -0.76). Resting heart rate, resting systolic blood pressure, and resting diastolic blood pressure decreased significantly (p < 0.05) after the intervention. Self-reported and accelerometry-measured frequency of MVPA increased significantly (p < 0.05), and the total MVPA minutes (~275 min/week) were above international recommendations. Change in VO₂max was significantly correlated with change in self-reported (r = 0.42) and accelerometry-measured (r = 0.24) MVPA minutes. No significant changes were observed in weight, body mass index, waist circumference, body fat (via bioelectrical impedance), grip strength, and flexibility. These findings demonstrate that a culturally relevant and safe, community-based, Indigenous-led, health and wellness intervention can lead to significant and clinically relevant improvements in cardiometabolic health and physical activity behaviour, with the greatest changes being observed in the least active/fit individuals.

A systematic review and meta-analysis of cardiorespiratory fitness among Indigenous populations in North America and circumpolar Inuit populations

Indigenous populations experience health disparities including increased obesity, diabetes and cardiovascular disease rates. Cardiorespiratory fitness is beneficial for maintaining positive health outcomes. The objective of this systematic review is to evaluate cardiorespiratory fitness among Indigenous populations including comparisons across genders, Indigenous identities, age groups, decades, socio-demographic variables and in comparison to non-Indigenous groups. Included articles reported various cardiorespiratory fitness measures using maximal treadmill or cycle ergometer tests, 20 m shuttle run, 1 mile run/walk test and 6 min walk test. From 14 databases searched in March 2017, including MEDLINE, EMBASE and Scopus, 1069 citations were evaluated and 39 articles included, representing 32 investigations and 10,579 individuals. First Nations/American Indian (FN/AI) adults have greater cardiorespiratory fitness than Inuit. Inuit and FN/AI men and boys have higher cardiorespiratory fitness than women and girls. Lower cardiorespiratory fitness is associated with obesity, metabolic syndrome and a western lifestyle. Cardiorespiratory fitness has declined among Inuit adults, averaging 51.7 ± 7.9 mL·kg^-1·min^-1 in 1970 to 37.7 ± 6.9 mL·kg^-1·min^-1 in 2000. Among men, FN/AI have greater cardiorespiratory fitness compared to European-descents, and European-descents have greater cardiorespiratory fitness compared to Inuit. The 1 mile run/walk time showed that FN/AI boys, girls, and youth had faster times compared to European-descendants, but 20 m shuttle run showed that European-descent boys and youth advanced to further stages compared to FN/AI populations. Cardiorespiratory fitness is declining, and among some Indigenous populations to lower levels than European-descent populations. Improving cardiorespiratory fitness for Indigenous populations should be considered a primary health strategy.

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).

A systematic review on research into the effectiveness of group-based sport and exercise programs designed for Indigenous adults

OBJECTIVES

To evaluate research into the effectiveness of group-based sport and exercise programs targeting Indigenous adults on anthropometric, physiological and quality of life outcomes.

DESIGN

A systematic review with quality assessment of study design.

METHODS

A computer-based literature search of EBSCO, SPORTDiscus, CINAHL, Informit, Scopus, Web of Science, Medline, PubMed, Global Health, ProQuest and Discover databases was conducted. Methodological quality of individual articles was assessed using McMasters University Guidelines and Appraisal Forms for Critical Review for Quantitative Research. Results of the effectiveness of programs are then summarised.

RESULTS

Six articles were identified with critical appraisal scores ranging from 6 to 12 (from a possible 15 points), with a mean score of 9.6. Five articles were of moderate to good quality. Significant improvements were observed in anthropometric, physiological and quality of life outcomes across all studies. Elements of successful group-based exercise and sport programs corresponded to global recommendations on physical activity for health for 18 to 64 year olds, and were implemented over a period of time ranging from 12 to 24 weeks to exhibit results, plus community consultation in developing programs and nutrition education.

CONCLUSIONS

Group-based programs that include nutrition, exercise and/or sport components are effective in producing short to intermediate term health outcomes among Indigenous adults. Further high quality research, specifically on group-based modified sport programs for Indigenous adults that are culturally appropriate and aim to improve quality of life are needed.

Best Practices for the Prevention and Management of Diabetes and Obesity-Related Chronic Disease among Indigenous Peoples in Canada: A Review

OBJECTIVES

To carry out a systematic review of interventions that have aimed at improving screening, treatment, prevention and management of type 2 diabetes and obesity-related chronic disease in Indigenous communities in Canada from 2008 to 2014, with the aim of identifying current best practices.

METHODS

A comprehensive literature review was carried out through an electronic database search using Medline, EMBASE, PubMED and Google scholar.

RESULTS

We identified 17 publications, comprising 13 evaluated interventions. Of them, 7 were school-based programs focused on children, 5 focused on adults, and 1 included both adults and children. Most interventions aimed at encouraging behaviour change, especially dietary change, but did little to address the underlying context of systemic marginalization and colonialism experienced in many Indigenous communities. Interventions focused on improving fitness were more effective than those aimed at dietary change. Overall, we found a range of successes among these interventions. Those that met with limited success reported that complex social issues and poverty presented challenges to effective intervention work in these communities. Participatory action research methods and community ownership of the intervention were found to be essential for project success.

CONCLUSIONS

Diabetes-focused intervention research in Indigenous communities appears to be a low priority for Canadian funders and policymakers. More intervention research is urgently needed in these communities. To be effective, this work must take an approach that is historically deep and sufficiently broad as to enable the ideologic, policy and institutional changes necessary in order to achieve true equity. This will involve addressing colonialism, racism and social exclusion as broader determinants of health.

An Updated Review of Interventions that Include Promotion of Physical Activity for Adult Men

The marked disparity in life expectancy between men and women suggests men are a vulnerable group requiring targeted health promotion programs. As such, there is an increasing need for health promotion strategies that effectively engage men with their health and/or illness management. Programs that promote physical activity could significantly improve the health of men. Although George et al. (Sports Med 42(3):281, 30) reviewed physical activity programs involving adult males published between 1990 and 2010, developments in men's health have prompted the emergence of new sex- and gender-specific approaches targeting men. The purpose of this review was to: (1) extend and update the review undertaken by George et al. (Sports Med 42(3):281, 30) concerning the effectiveness of physical activity programs in males, and (2) evaluate the integration of gender-specific influences in the content, design, and delivery of men's health promotion programs. A search of MEDLINE, CINAHL, ScienceDirect, Web of Science, PsycINFO, the Cochrane Library, and the SPORTDiscus databases for articles published between January 2010 and August 2014 was conducted. In total, 35 studies, involving evaluations of 31 programs, were identified. Findings revealed that a variety of techniques and modes of delivery could effectively promote physical activity among men. Though the majority of programs were offered exclusively to men, 12 programs explicitly integrated gender-related influences in male-specific programs in ways that recognized men's interests and preferences. Innovations in male-only programs that focus on masculine ideals and gender influences to engage men in increasing their physical activity hold potential for informing strategies to promote other areas of men's health.

A systematic review of physical activity levels in Native American populations in Canada and the United States in the last 50 years

Physical activity is beneficial for many chronic conditions. However, activity levels of Native Americans are not well known. This systematic review investigated if Native American populations achieve the recommended physical activity levels, compared current and past activity levels, and assessed the ability of exercise training programmes to improve health outcomes among this population. Electronic databases (e.g. MEDLINE, EMBASE) were searched and citations were cross-referenced. Included articles reported physical activity levels or investigations among Native Americans. This search identified 89 articles: self-report (n = 61), accelerometry and pedometry (n = 10), metabolic monitoring (n = 10) and physical activity interventions (n = 17). Few adults were found to meet the physical activity recommendations (27.2% [95% confidence interval = 26.9-27.5%] self-report, 9% [4-14%] accelerometry). Among children/youth, 26.5% (24.6-28.4%) (self-report) to 45.7% (42.3-49.1%) (pedometry/accelerometry) met the recommendations. Adults and children/youth were generally identified as physically inactive (via doubly labelled water). Overall, Native American adults reported lower activity levels since 2000, compared to 1990s, although similar to 1980s. Few physical activity interventions employed strong methodologies, large sample sizes and objective outcome measures. There is a clear need to increase Native American populations' physical activity. Additional research is required to evaluate exercise training programmes among this population.