Promoting Physical Activity Among Native American Youth: a Systematic Review of the Methodology and Current Evidence of Physical Activity Interventions and Community-wide Initiatives

Abstract

Promoting physical activity using environmental, policy, and systems approaches could potentially address persistent health disparities faced by American Indian and Alaska Native children and adolescents. To address research gaps and help inform tribally-led community changes that promote physical activity, this review examined the methodology and current evidence of physical activity interventions and community-wide initiatives among Native youth. A keyword guided search was conducted in multiple databases to identify peer-reviewed research articles that reported on physical activity among Native youth. Ultimately, 20 unique interventions (described in 76 articles) and 13 unique community-wide initiatives (described in 16 articles) met the study criteria. Four interventions noted positive changes in knowledge and attitude relating to physical activity but none of the interventions examined reported statistically significant improvements on weight-related outcomes. Only six interventions reported implementing environmental, policy, and system approaches relating to promoting physical activity and generally only shared anecdotal information about the approaches tried. Using community-based participatory research or tribally-driven research models strengthened the tribal-research partnerships and improved the cultural and contextual sensitivity of the intervention or community-wide initiative. Few interventions or community-wide initiatives examined multi-level, multi-sector interventions to promote physical activity among Native youth, families and communities. More research is needed to measure and monitor physical activity within this understudied, high risk group. Future research could also focus on the unique authority and opportunity of tribal leaders and other key stakeholders to use environmental, policy, and systems approaches to raise a healthier generation of Native youth.

Cardiovascular Disease in American Indian and Alaska Native Youth: Unique Risk Factors and Areas of Scholarly Need

“…One systematic review identified 33 physical activity interventions in US tribal communities published between 1970 and 2015. Twenty were research‐based interventions and 13 were community‐wide initiatives . None reported statistically significant improvements in weight‐related outcomes, and only 4 reported improvements in knowledge or attitudes regarding physical activity .…”

“…Twenty were research‐based interventions and 13 were community‐wide initiatives . None reported statistically significant improvements in weight‐related outcomes, and only 4 reported improvements in knowledge or attitudes regarding physical activity . The community‐wide studies did not share systematic information or analysis on the local environment, policy, or system‐based approaches.…”

Effectiveness of lifestyle interventions in preventing harmful weight gain among adolescents: A systematic review of systematic reviews

“…The topics addressed have ranged from (but are not limited to) investigating frameworks (ethical issues/evaluation/policy/external validity/theoretical underpinning), 7–18 intervention mediums (social media), 19–23 intervention setting (school, community etc. ), 24–35 macro factors linked to obesity (ethnicity, race and socioeconomic status), 36,37 improving nutrition/fruit and vegetable intake, 13,38–44 increasing physical activity/reducing sedentary behaviour, 33,35,45–57 reducing sugar sweetened beverage intake 58,59 and improving psychological states (depression) 60,61 …”

“…The topics addressed have ranged from (but are not limited to) investigating frameworks (ethical issues/evaluation/policy/external validity/theoretical underpinning), [7][8][9][10][11][12][13][14][15][16][17][18] intervention mediums (social media), [19][20][21][22][23] intervention setting (school, community etc. ), [24][25][26][27][28][29][30][31][32][33][34][35] macro factors linked to obesity (ethnicity, race and socioeconomic status), 36,37 improving nutrition/fruit and vegetable intake, 13,[38][39][40][41][42][43][44] increasing physical activity/reducing sedentary behaviour, 33,35,[45][46][47][48][49][50][51]…”

Health Care Provider’s Role in Obesity Prevention and Healthy Development of Young American Indian Children

“…Collaborative efforts across HCPs, ECE teachers, and parents are essential for environmental changes (Fleischhacker, Roberts, Camplain, Evenson, & Gittelsohn, 2016). These collaborative efforts are encouraged by the National Academies of Sciences (NAS) formerly known as Institute of Medicine (2010, 2012; NAS, 2016) and American Academy of Pediatrics (Kuo, Thomas, Chilton, Mascola, & Council on Community Pediatrics, Section on Epidemiology, Public Health, and Evidence, 2018).…”