Build it and they will come: outcomes from a successful cardiac rehabilitation program at an Aboriginal Medical Service

Abstract

Objective. Cardiovascular disease (CVD) is the leading disease burden in Aboriginal Australians, but culturally appropriate cardiac rehabilitation programs are lacking. We evaluated the uptake and effects on lifestyle, and cardiovascular risk factors, of cardiac rehabilitation at an Aboriginal Medical Service (AMS).Methods. The program involved weekly exercise and education sessions (through 'yarning') for Aboriginal people with or at risk of CVD. Participants' perceptions of the program and the impact on risk factors were evaluated following 8 weeks of attendance.Results. In twenty-eight participants (20 females) who completed 8 weeks of sessions, body mass index (34.0 AE 5.1 v. 33.3 AE 5.2 kg m -2 ; P < 0.05), waist girth (113 AE 14 v. 109 AE 13 cm; P < 0.01) and blood pressure (135/78 AE 20/12 v. 120/72 AE 16/5 mmHg; P < 0.05) decreased and 6-min walk distance increased (296 AE 115 v. 345 AE 135 m; P < 0.01). 'Yarning' helped identify and address a range of chronic health issues including medication compliance, risk factor review and chest pain management.Conclusions. AMS-based cardiac rehabilitation was well attended, and improved cardiovascular risk factors and health management. An AMS is an ideal location for managing cardiovascular health and provides a setting conducive to addressing a broad range of chronic conditions.What is known about the topic? Cardiovascular disease is the leading cause of morbidity and mortality in Aboriginal Australians, but less than 5% of eligible Aboriginal people attend hospital-based cardiac rehabilitation.

Health and wellbeing outcomes of programs for Indigenous Australians that include strategies to enable the expression of cultural identities: a systematic review

“…Of these Eley et al (2010) detected improved outcomes for Study 1 but not Study 2 or for two subsequent iterations of the program. For eight interventions described in the study, observed improvements were statistically significant (O'Dea 1984; Lee et al 1994;Rowley et al 2001;d'Espaignet et al 2003;Nagel et al 2009;Eley et al 2010;Dimer et al 2013;Sun and Buys 2013). Two studies where statistical analyses were not conducted show positive directions of effects in health and wellbeing outcomes (Nel and Pashen 2003;Preuss and Brown 2006) (Table 1).…”

“…Eley et al (2010) showed improved outcomes only for senior school boys in one of two described studies. The study related to physical activity with the most highly rated design (Dimer et al 2013) showed a range of significant clinical improvements. However, even this study only reported outcome data for a small proportion of those who commenced the program.…”

“…They include visiting Country and cultural sites (O'Dea 1984;Preuss and Brown 2006), education in traditional cultural practices (Preuss and Brown 2006), hunting, fishing and eating bush foods (O'Dea 1984; Rowley et al 2001), traditional games (Kiran and Knights 2010) yarning (an Indigenous mode of talking) and sharing cultural stories (Lee et al 1994;Dimer et al 2013), mapping and activating cultural relationships of care (d'Espaignet et al 2003;Nel and Pashen 2003;Nagel et al 2009), reinforcing Elder authority (Preuss and Brown 2006) and painting, dancing, playing instruments and singing as a community (Dimer et al 2013;Sun and Buys 2013). Programs were implemented in a range of locations.…”

“…In 2012, Dimer et al (2013) published outcomes from a cardiac rehabilitation program in an Aboriginal Medical Service in Perth, WA. As part of an exercise program, staff tracked participants' progress on a map so they could envisage where they would have travelled through traditional Country if using a conventional bicycle.…”

“…based had the same characteristics as the 98 people who commenced the program. Two of these studies (Eley et al 2010;Dimer et al 2013) were rated as high or moderately high for study design. The study by Sun and Buys (2013) was rated as moderate on study design, and that of Kiran and Knights (2010) as low.…”