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

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

Associations of Cultural Characteristics with Sedentary Behaviour and Screen Time Among Indigenous Adults in Saskatchewan

BACKGROUND

Indigenous Peoples: First Nations, Métis and Inuit, have experienced significant disruptions of physical, mental, emotional and spiritual health and well-being through centuries of ongoing colonization and assimilation. Consequently, breakdown of cultural connections, increasingly sedentary lifestyles and high levels of screen time contribute to health inequity experiences.

PURPOSE

The purpose of this study is to examine associations of cultural connectedness with sedentary behaviour and the influence of relocation from home communities for Indigenous Peoples in Saskatchewan.

METHODS

Cultural connectedness, sedentary and screen time behaviour were evaluated through online questionnaires among 106 Indigenous adults. Within Indigenous identities, 2 × 2 factorial ANOVA compared cultural connectedness scores with sedentary behaviour and traditional activity participation by relocation from home communities.

RESULTS

Among First Nations and specifically Cree/Nehiyawak who relocated from home communities, positive associations of cultural connectedness scores with sedentary behaviour and screen time were identified, with no associations identified among those not relocating. Among Métis who did not relocate, greater ethnic identity, identity, spirituality and cultural connectedness (57.8 ± 5.36 vs. 81.25 ± 16.8; p = 0.02) scores were reported among those reporting 5 or more hours of continuous sitting.

CONCLUSIONS

Cultural connectedness associations with sedentary behaviour depend on relocation from home communities and differ between First Nations and Métis. Understanding associations of sedentary behaviour specific to First Nations and Métis populations may enable appropriate strategies to improve health outcomes.

Social Determinants Associated with Physical Activity among Indigenous Adults at the University of Saskatchewan

Colonization impacts Indigenous Peoples' way of life, culture, language, community structure and social networks. Links between social determinants of health and physical activity (PA) among Indigenous Peoples in Saskatchewan, with 16% Indigenous residents, are unclear. This cross-sectional study guided by Indigenous Community Advisors, compared moderate-to-vigorous PA (MVPA), traditional Indigenous PA and musculoskeletal PA with social determinants of Indigenous, (n=124), including First Nations (n=80, including 57 Cree/Nehiyawak) and Métis (n=41), adults in Saskatchewan. Participants completed Godin-Shephard Leisure-Time PA, Social Support Index and traditional Indigenous PA participation questionnaires. Regression associated positive perception of social support with MVPA (R=0.306, p=0.02), while residential school experiences (R=0.338, p=0.02) and community support (R=0.412, p=0.01) were associated with traditional Indigenous PA participation. Among Métis, discrimination experiences were associated with traditional Indigenous PA participation (R=0.459, p=0.01). Traditional Indigenous PA participation was associated with community support among First Nations (R=0.263, p=0.04), and also foster care placement (R=0.480, p=0.01) for Cree/Nehiyawak First Nations specifically. Among Cree/Nehiyawak, family support (R=0.354, p=0.04), discrimination experiences (R=0.531, p=0.01) and positive perceptions of support (R=0.610, p=0.003) were associated with musculoskeletal PA. Greater community, family and perceived social support, and experiences of discrimination, residential school and foster care are associated with more PA for Indigenous Peoples. Novelty: • Positive support perceptions predict physical activity among Indigenous Peoples • Family support, discrimination experiences and positive support perceptions predict physical activity for Cree/Nehiyawak First Nations. Traditional physical activity was predicted by residential school experiences and community support (Indigenous Peoples), discrimination experiences (Métis), community support (First Nations), and foster care experiences (Cree/Nehiyawak).

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.

Cultural connectedness as a determinant of physical activity among Indigenous adults in Saskatchewan

Cultural connectedness has been associated with increased self-esteem and mental health among Indigenous Peoples. Physical activity is an important contributor to health, although the importance of culture as a determinant of physical activity for Indigenous Peoples in Canada is unclear. The purpose of this study is to evaluate differences in cultural connectedness between Indigenous adults in Canada achieving high and low physical activity levels. Questionnaires evaluated cultural connectedness and physical activity. Indigenous adults were classified into high and low physical activity groups at the specific group mean and as meeting or not meeting musculoskeletal activity guidelines of twice per week. First Nations and specifically Cree/Nehiyaw First Nations adults who were more physically active reported greater identity, spirituality, traditions, exploration, commitment, affirmation/belonging, and overall cultural connectedness. Cultural connectedness elements of commitment, exploration, identity, affirmation/belonging, traditions, spirituality, and overall cultural connectedness were not different between high and low physical activity Métis adults. Musculoskeletal activity was not associated with any elements of cultural connectedness among any Indigenous identity. Cultural connectedness is a protective factor for physical activity among First Nations and Cree/Nehiyaw First Nations adults, but not among Métis adults in Canada. Novelty Musculoskeletal activity was not associated with cultural connectedness. Cultural connectedness is a protective factor of physical activity for First Nations adults. Moving away from one's home community was associated with lower cultural connectedness for Indigenous Peoples.

Ethnic differences in the cardiac responses to aerobic exercise

Background: Cardiovascular disease disproportionately affects North American Indigenous populations. Ethnic differences in cardiac responses to exercise are known, though Indigenous populations response is unknown. To evaluate cardiac responses to aerobic exercise among Canadian Indigenous and European adults. Methods: Indigenous (N = 12, 4 females, 1 male incomplete) and European (N = 12, all completed) Canadian age and sex-matched adults 19-40 years and free of cardiovascular disease or diabetes completed a cycle ergometer maximal aerobic power test and 30 min at 60% maximal aerobic capacity on two separate days. Echocardiographic assessments preceded and immediately followed exercise. Results: Responses to maximal exercise were similar among ethnicities including decreases in stroke volume index, cardiac output index and ejection fraction, and increases in arterial-ventricular coupling. However, following submaximal exercise, only Indigenous adults demonstrated reductions in end systolic volume, end diastolic volume (154.8 ± 40.6 mL to 136.5 ± 33.0 mL, p = 0.01, vs. 149.4 ± 22.4 mL to 147.1 ± 27.0 mL; p = 0.81), stroke volume index (44.9 ± 8.7 mL m^-2 to 38.0 ± 6.5 mL m^-2, p = 0.002, vs. 46.4 ± 7.1 mL m^-2 to 44.0 ± 6.5 mL m^-2; p = 0.28) and arterial compliance. Conclusion: Indigenous and European adults demonstrated similar cardiac responses to maximal exercise, though only Indigenous adults demonstrated cardiac responses to submaximal exercise.

Cardiovascular dynamics of Canadian Indigenous peoples

Limited understanding of Indigenous adults' cardiovascular structure and function exists despite high rates of cardiovascular disease. This investigation characterised cardiovascular structure and function among young Indigenous adults and compared to age- and sex-matched European descendants. Echocardiographic assessments included apical two- and four-chamber images, parasternal short-axis images and Doppler. Analyses included cardiac volumes, dimensions, velocities and strains. Cardiovascular structure and function were similar between Indigenous (n=10, 25 ± 3 years, 4 women) and European-descendant (n=10, 24 ± 4 years, 4 women,) adults, though European descendants demonstrated greater systemic vascular resistance (18.19 ± 3.94 mmHg∙min-1∙L-1 vs. 15.36 ± 2.97 mmHg∙min-1∙L-1, p=0.03). Among Indigenous adults, women demonstrated greater arterial elastance (0.80 ± 0.15 mmHg·mL-1·m-2 vs. 0.55 ± 0.17 mmHg·mL-1·m-2, p=0.02) and possibly greater systemic vascular resistance (17.51 ± 2.20 mmHg∙min-1∙L-1 vs. 13.93 ± 2.61 mmHg∙min-1∙L-1, p=0.07). Indigenous men had greater cardiac size, dimensions and output, though body size differences accounted for cardiac size differences. Similar cardiac rotation and strains were observed across sexes. Arterial elastance and cardiac size were different between Indigenous men and women while cardiovascular structure and function may be similar between Indigenous and European descendants.

Ethnic differences in vascular function and factors contributing to blood pressure

OBJECTIVE

Indigenous populations experience greater proportions of cardiovascular disease, diabetes, and obesity, though lower rates of hypertension. This investigation evaluated blood pressure relationships with vascular measures, anthropometry, cultural identity, and smoking status among Canadian Indigenous and European adults.

METHODS

In 2013, in Vancouver, Canada, blood pressure, anthropometry, cultural identity, smoking status, pulse wave velocity (PWV), arterial compliance, baroreceptor sensitivity, and intima-media thickness (IMT) were directly measured among 58 Indigenous (39 ± 18 years, 31 female) and 58 age- and sex-matched European Canadian (42 ± 18 years) adults. Systolic (SBP) and diastolic (DBP) blood pressures were related to vascular measures, and hypertension was related to anthropometry, cultural identity, and smoking status.

RESULTS

Similar vascular measures were recorded between Indigenous and European adults, respectively (PWV 5.3 ± 2.4 vs. 6.2 ± 3.4 m s^-1, p = 0.12; IMT 0.59 ± 0.11 vs. 0.61 ± 0.11 mm, p = 0.40; and large arterial compliance 16.1 ± 6.4 vs. 17.5 ± 6.6 mL mmHg^-1 × 10, p = 0.26). Similar relationships between vascular measures with SBP and DBP were identified between Indigenous and European adults (spectral baroreceptor sensitivity and SBP, r = 0.48, p = 0.001 vs. r = - 0.11, p = 0.44; ethnic difference p = 0.38; PWV; and DBP, r = 0.23, p = 0.09 vs. r = 0.06, p = 0.65, ethnic difference p = 0.23). Anthropometry only related to blood pressures among Europeans. Cultural identity only related to blood pressures among Indigenous populations. Smoking was not related to hypertension.

CONCLUSION

Similar vascular measures between Indigenous and European Canadians were identified among populations experiencing similar social determinants of health.

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 and meta-analysis of exercise and exercise hypertension in patients with aortic coarctation

Exercise hypertension is a common occurrence among individuals with aortic coarctation. Although exercise is known to be beneficial among the general population, the risks and benefits of exercise among those with aortic coarctation are less clear. This systematic review evaluates the benefits and risks of exercise for persons with aortic coarctation. Electronic databases were systematically searched (that is, MEDLINE and EMBASE) and key reviews cross-referenced to identify articles for inclusion. Original research articles reporting exercise among individuals with aortic coarctation were included. From 2608 individual citations, 68 eligible articles were identified. Aerobic exercise stress tests were found to be useful for determining exercise hypertension experiences post-surgical repair (N=5), and other long-term secondary findings (N=3). Experiences of exercise hypertension were associated with abnormal cardiac and/or aortic geometry and cardiac function (N=7). Exercise capacity was generally found to be similar to non-aortic coarctation controls post surgery (N=6). Exercise hypertension was experienced by 27% of participants, including 10% of adults and 43% of children/youth. Individuals who experience exercise hypertension experience greater increases in systolic blood pressure with exercise. No investigations identified evaluated forms of exercise other than aerobic stress tests and no exercise training programs have been conducted to date. Exercise stress tests can be valuable in this population for determining exercise hypertension, especially in the year post-surgical repair. Additional research is urgently needed to accurately assess the benefits and risks of exercise and exercise hypertension, and applicability of exercise restrictions for this population.

A systematic review and meta-analysis of screen time behaviour among North American indigenous populations

Screen time (computer, television, video game and smartphone/tablet activity) is associated with increased obesity and other health risks. This systematic review evaluates screen time among North American Indigenous populations and compares it with that of North American Europeans. Electronic databases (e.g. MEDLINE and EMBASE) were searched, and citations cross-referenced. Included articles reported screen time among First Nations/American Indians, Métis, Inuit/Alaskan Natives or Native Hawaiians. From 788 citations evaluated, 40 identified articles report television, video game, computer and/or overall screen time. Overall screen time was 3.65 ± 1.26 h day(-1) (n = 2,242, 8 articles) among Indigenous children/youth and 3.61 ± 2.95 h day(-1) (n = 155, 1 article) among adults. Among children/youth, 66.0% (n = 11 256, 9 articles) reported less than 2 h day(-1) of television screen time, while only 52.8% (n = 2,458, 1 article) of adults reported this volume. Screen time was generally greater among male population, youth, First Nations/American Indians and overweight/obese individuals. Indigenous children/youth reported greater overall screen time than North American Europeans (4.81 ± 2.84 h day(-1) , n = 1,182 vs. 3.40 ± 2.81 h day(-1) , n = 2,785; 3 articles; p < 0.0001). Screen time is common among North American Indigenous populations. Further research evaluating interventions to reduce screen time and chronic disease risks is required.

Evidence-based risk recommendations for best practices in the training of qualified exercise professionals working with clinical populations

This systematic review examines critically "best practices" in the training of qualified exercise professionals. Particular attention is given to the core competencies and educational requirements needed for working with clinical populations. Relevant information was obtained by a systematic search of 6 electronic databases, cross-referencing, and through the authors' knowledge of the area. The level and grade of the available evidence was established. A total of 52 articles relating to best practices and (or) core competencies in clinical exercise physiology met our eligibility criteria. Overall, current literature supports the need for qualified exercise professionals to possess advanced certification and education in the exercise sciences, particularly when dealing with "at-risk" populations. Current literature also substantiates the safety and effectiveness of exercise physiologist supervised stress testing and training in clinical populations.

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.

Greater prevalence of select chronic conditions among Aboriginal and South Asian participants from an ethnically diverse convenience sample of British Columbians

Canadians currently experience elevated rates of chronic conditions compared with past populations, and ethnic differences in the experience of select chronic conditions have previously been identified. This investigation examined the prevalence of select chronic conditions among an ethnically diverse convenience sample of British Columbian adults. A sample of adults (≥18 years) from around the province of British Columbia, including Aboriginal (n = 991), European (n = 3650), East Asian (n = 466), and South Asian (n = 228), were evaluated. Individuals reported their personal histories of cardiovascular disease and diabetes, and physical activity behaviour. Direct measures of health status included body mass index, waist circumference, resting blood pressure, and nonfasting blood glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, and glycosylated hemoglobin A1C. All ethnic groups were found to have high rates of low HDL (>33%), physical inactivity (>31%), hypertension (>16%), and ethnic-specifically defined obesity (>23%) and abdominal obesity (>33%). Aboriginal and South Asian populations generally demonstrated higher rates of select chronic conditions. The implementation of ethnic-specific body composition recommendations further underscores this poorer health status among South Asian populations. Actions to improve chronic condition rates should be undertaken among all ethnic groups, with particular attention to Aboriginal and South Asian populations.

The prevalence of overweight and obesity in British Columbian Aboriginal adults

Overweight and obesity among Aboriginal populations has been a growing challenge within Canada. This investigation aimed to identify the prevalence of overweight and obesity within British Columbian adult Aboriginal populations including both on and off reserve individuals through direct measurement. Further, this study stratified the variations in these rates according to age, gender and geographic region. Weight, height and waist circumference (WC) were measured via standardized procedures, and body mass index (BMI) was calculated. The mean body composition indicators were above recommended for men (BMI = 30.3 ± 5.6 kg m(-2) ; WC = 104.2 ± 14.7 cm) and women (BMI = 30.9 ± 7.2 kg m(-2); WC= 99.3 ± 17.1 cm), respectively. Rates of obesity for men and women were similar, 48.4% and 48.7%, respectively, and showed significant increases with age. Abdominal obesity (AO) was significantly greater among female participants, 69.0% compared with 52.7% in men, while both genders also demonstrated significant increases in AO with age. Both obesity and AO rates were found to be significantly greater in the Northern and Interior regions of the province in comparison to the Vancouver/Lower Mainland region. Alarmingly high rates of obesity and AO were observed in this population in men and women at every age and geographic region.