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

Abstract

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.

Health Benefits of Physical Activity: A Strengths-Based Approach

“…By making small changes in my activities, I can meet my goal to be happier and healthier. The application of strengths-based approaches has increasingly been used in diverse environments (such as the workplace and clinical settings [45,50,52,54,55]), communities, and populations (e.g., children, Indigenous communities) [48,49,[56][57][58][59]. For instance, Zhang et al [50] in a recent systematic review and meta-analysis of randomized controlled trials, revealed that strengths-based, solution-focused brief therapy in medical settings had a significant effect on health-related psychosocial outcomes (e.g., depression, psychosocial adjustment to illness), with positive indicators for health-related behavioral outcomes (e.g., physical activity, nutrition score).…”

“…Strengths-based approaches to health and wellness have increasingly been used within Indigenous communities throughout the world [48,49,57,58,63]. Indigenous peoples have acknowledged the need to consider health and wellness from a more wholistic perspective (including spiritual, emotional, mental, and physical wellbeing) reflecting a balance of human relationships with the natural and spiritual world, including connections amongst the land, individuals, family, community, and cultural and spiritual practices [63].…”

“…Strengths-based approaches to health and wellness have gradually been advocated [45][46][47]. Strengths-(or assets-) based approaches are internally focused, building upon the aspirations, innate strengths, and opportunities/resources of individuals, families, and communities serving as the foundation to build upon to improve health and wellness [47][48][49][50]. As outlined recently by Zhang and colleagues [50], a strengths-based approach includes the client's resources and preferred future rather than focusing on the past histories or health problems (deficits).…”

“…This process allows clients to increase their perceptions regarding their abilities, enhance clients' options and perceptions of these options, and increase the confidence and opportunities of clients to choose and act on these choices [52]. In physical activity promotion, identifying strengths related to physical activity participation and connecting with other people, communities, and culture can build hope towards enhancing health and wellbeing [48].…”

Multidisciplinary lifestyle intervention in children and adolescents - results of the project GRIT (Growth, Resilience, Insights, Thrive) pilot study

“…The results demonstrated that study completers improved diet quality through an increased proportion of energy intake from healthy core foods and decreased discretionary foods, and improved self-concept, particularly with regards to the physical appearance and attributes domain. Cardiorespiratory fitness was not significantly improved at follow-up, although mean absolute VO 2 peak increased 5%; a comparable modest increase to previous intervention studies in children [47]. Despite being satisfied with the program, few recruited participants met the attendance goals and the attrition rate was higher than expected.…”