This Wikibooks page is a review of the journal article Effectiveness of a community-directed ‘healthy lifestyle’ program in a remote Australian Aboriginal community by Rowely KG. et al. (2000)  focusing on the exercise component of the program
What is the background to this research?
The risk of death and reduced life span of Australian Aborigines due to diseases, with a linkage to lifestyle, such as diabetes, cardiovascular disease (CVD) and coronary heart disease (CHD) or stroke is significantly higher than non-aboriginal Australians. Adopting a westernised lifestyle with low levels of physical activity and a diet containing processed foods high in carbohydrates and fats can lead to obesity and insulin resistance in comparison to the traditional hunter and gather lifestyle with high physical activity levels and a diet low in fat but high in fibre. Studies have shown that when both diabetic and non-diabetic aborigines reverted to a traditional hunter gatherer life style they experienced an improvement in carbohydrate and lipid metabolism leading to improved health outcomes. Health campaigns designed with the general Australian Public have very limited effectiveness in remote aboriginal communities due to many reasons including language and or inappropriate message but initiatives coming from and being run by communities have greater effectiveness in remote Aboriginal Communities.
Where is the research from?
The research was carried out by a team of researchers based at the Centre for Population Health and Nutrition, Monash Medical Centre at Monash University in Victoria Australia looking at a healthy life style intervention in the Looma Aboriginal community which is located in the remote Kimberly region in north western Australia.
What kind of research was this?
This research originated as a cohort study of two years and was supplemented by a cross-sectional study of the community based on surveys over a four year period.
What did the research involve?
Interventions were applied to a group of 96 overweight diabetic community members who were high risk for further lifestyle diseases over a two year period. These interventions included:
- Education sessions (a combination of formal and informal)
- Dietary changes (more fruit and vegetables, lower sugar and lower fat)
- Cooking classes and tours of the store
- Physical activity groups
- Hunting trips
- Participation in sport
- Walking groups
Measurements of weight and blood glucose levels were taken every week and a follow up was carried out every 6 months of the 2 year period with key measures being body mass index (BMI) and metabolic control. At the first 6 month follow up participants were sorted into 2 groups of intervention and non-intervention depending on if they were doing the interventions or not.
As awareness spread through interaction of participants with other community members a wider application interventions began leading to lifestyle changes throughout the community through health promotion with researchers also providing the following:
- Help with dealing with health and funding bodies
- Data analysis and results feedback
- Technical advice
What were the basic results?
- 82% of participants were overweight or obese and the intervention and non-intervention groups had very similar baseline characteristics measurements
- Over the 2 years participants BMI decreased compared to the baseline
- At 6 months the BMI change was larger in the intervention group than the non-intervention group but this difference had disappeared by 12 months
- The blood glucose for the group changed over the 2 years with a significant reduction at 6 months
- The change in blood glucose levels had disappeared at 12 months
- There was no difference between between the blood glucose levels of intervention and non-intervention groups in the first 12 months
- Insulin concentrations varied over the 2 year period with a lower mean concentration at 18 months
- The insulin levels in the 2 years were higher for the non-intervention group
- Within the community several sporting teams were reactivated and contained some older community members
- The council appointed an official sport and recreation officer
- The number of sedentary individuals was lower after 2 years than the baseline and still lower after 4 years
- Less people were reporting that they weren’t trying to reduce fat and sugar in their diet and this trend was still visible after 4 years
- less younger people were responding to surveys than older people
How did the researchers interpret the results?
Although there was a reduction in BMI at the start of people who made dietary changes or physical activity changes, participants were not able to sustain this weight loss and when considering that young participants increased their BMI throughout the study it shows how difficult it is to maintain weight loss over time when starting from an obese baseline.
The significant reduction in insulin levels was not different between the intervention and non-intervention groups. An explanation for this suggested by the researchers is that the reduction is a seasonal one and reflects the eating habits of people in the cooler, less humid dry season in north western Australia. Researchers suggest that the most viable way of reducing the prevalence of diabetes considering this failure to maintain improvements is to prevent the development of diabetes in younger people in the first place and wait until they move into the next age bracket rather than trying to change the prevalence through interventions with older aborigine community members. Researchers believe that the improvement in insulin sensitivity is directly linked to increased physical activity and that this too is a seasonal factor as it is easier to exercise in the cooler dry months.
What conclusions should be taken away from this research?
Physical activity is an important component of lifestyle intervention programs helping to reduce disease risk in Australian Aborigines. When teamed up with a diet that is lower in fats and processed carbohydrates then significant health gains are possible. The key to reducing mortality rates in Australian Aborigines is sustainability of any lifestyle changes so that there are long term health benefits and risk reduction as risk increase again if interventions or changes are abandoned. It is also important that communities embrace the program and gain ownership through helping in the development and application of lifestyle programs to make sure they are relevant and meet needs of the community.
What are the implications of this research?
This research indicates that there are significant health benefits to be gained through application of community-directed lifestyle intervention programs that include physical activity and dietary changes to minimize the disease burden on Australian Aborigine communities. Providing support and funding will help bridge the health gap and lower mortatily rates from disease that are easily preventable by using modern activities and food sources to gain the benefits past aborigines enjoyed when following the hunter gather lifestyle and reversing the negative health impacts of adopting a westernised diet and physical activity levels.
- Rowley KG, Daniel M, Skinner K, Skinner M, White GA & O’Dea K. (2000). Effectiveness of a community-directed ‘healthy lifestyle’ program in a remote Australian Aboriginal community, Australian and New Zealand Journal of Public Health, 24 (2):136-44
- O’Dea K. (1991). Westernisation, insulin resistance and diabetes in Australian aborigines. The Medical Journal of Australia, 155(4), 258-264
- Vos T, Barker B, Begg S, Stanley L & Lopez AD. (2009). Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap. international Journal of Epidemiology, 38(2), 470-477.