Indigenous communities in Canada face a decreased life expectancy due to higher rates of chronic illnesses. Increased physical activity is considered a key factor in reducing the risks of these chronic diseases as well as improving overall health metrics. This systematic review, funded by the Canadian Institutes of Health Research, sought to evaluate the effect of physical activity interventions on physical activity participation and health outcomes in these high risk Indigenous communities. The results of the review demonstrated a lack of robust evidence to conclude any correlations between the interventions and the selected health metrics. However, it highlights the importance of using culturally specific programs and systems to evaluate and improve Indigenous health moving forward.
The indigenous population of Canada has historically been at higher risk for chronic disease and various health conditions relative to the rest of the Candian population. Based on recent studies, it is estimated that over 75% of First Nations adults will be diagnosed with type II diabetes. In addition, nearly 40% will develop multiple chronic conditions, compared to just 13% of the general Canadian population. These health inequities are the result of the rural nature of their communities, faster population growth rates (6x the general population), wealth disparity, and historical events such as colonization. With many traditional methods of interventions no longer applicable, it is essential that any such intervention be carefully designed to reflect the community values and needs of the given area. This review aims to evaluate and review physical activity interventions delivered among Indigenous populations in Canada to assess their impact on physical fitness, health outcomes, and chronic disease.
The first step to conducting the systematic review involved a thorough literature search. MEDLINE, PsycINFO, EMBASE, and CINAHL databases were searched for academic literature related to Indigenous populations and health and physical activity interventions. Studies that involved Indigeneous populations of Canada and individual- or community-level physical activity interventions and had outcomes such as physical activity participation, physical fitness, health status or occurrence/diagnosis of a lifestyle-related chronic disease were included. The final step was data extraction and quality assessment, where data and information of interest, including study population, settling, details of intervention, physical activity and health outcomes, and community engagements, was collected and cross-checked from the studies. Additionally, the Quality Assessment Tool for Quantitative Studies, a tool that incorporates study design, selection bias, data collection methods, and other aspects of a study, was used to evaluate and assign a rating to studies. Five studies were identified as meeting all eligibility criteria and selected for a narrative synthesis for the review.
Four of the selected studies included the First Nation communities and another looked at a community of Haida ancestry. The interventions in the studies were those implemented in rural Indigenous communities and/or on reserve land. Interventions were community-based and ranged from 13 weeks to 24 months in duration and were either dietary or physical activity focused. Overall, two of five intervention activities reported an increase in physical activity, and these increases were seen both following both a supervised training program and non-supervised activity with some education-based programming. One study specifically showed a decrease in physical activity over a 9-month diet and physical activity program, and this was attributed to the interventure filing to address environmental barriers to physical activity. Health outcomes of some of the studies were statistically significant decreases in BMI, waist circumference, and systolic blood pressure. All five studies also reported engagement with relevant community leaders or stakeholders as part of the invention development.
Discussion and Future Extensions
The results of the five intervention studies demonstrate that physical activity interventions among Indigienous adults have the potential to improve key health metrics, such as BMI, hypertension, and blood lipid levels. However, the current studies are lacking strong evidence to actually establish a direct correlation between intervention methods and improved health in indigienous adults. Overall, the weak quality of studies pertaining to this field must be addressed in order to address the health disparity of Canadian ethnic groups and effectively modify health policy.
A key issue with many of the existing studies is that they did not properly address the barriers that impact overall inidgienous physical activity. This includes high levels of crime, lack of transportation, lack of community based physical activity, and also minimal access to affordable recreation centers. These barriers also include cultural ones, specifically the lack of a connection between physical activity and Indigeneous values and traditional practices. Preliminary research has shown that physical activity associated with socially and economically necessary tasks, such as berry picking and fishing, are preferred among Indigenous adults. This gives them a much greater chance of continuing to adhere to the routine. However, the lack of strong evidence on this topic also prevents researchers from making any concrete recommendations.
In conclusion, there are preliminary studies which demonstrate improved chronic disease risk due to community-based physical activity interventions. However, there is still a lot of work and research to be done in assessing the best strategy to address the health disparity in this high risk population. This includes addressing underlying barriers to entry, such as those mentioned previously, but also moving away from western-based activities which may not address the underlying cultural practices which affect health outcomes.
Connecting to GRC Project
The results of this study can be used to inform future exercise interventions with Indigineous Communities in Canada, and particularly can inform the work of Lift4Life, a recent nonprofit client of GRC MIT. Lift4Life had been interested in expanding its target population to indigineous communities in Canada, so one of GRC’s primary recommendations of a sustainable revenue source to Lift4Life was working with True North Aid and the Indigenous and Northern Initiatives Fund, two funds supporting projects directly impacting indigenous communities with up to twenty-five thousand dollars. This would be used to expand Lift4Life and fund building a community center/gym in one of the many existing communities within Canada. The preliminary results of this study suggest that Lift4Life will have the ability to impact communities both physically and emotionally with its provision of accessible strength training, and suggest promise in Lift4Life’s approach to expanding impact via Indigenous communities. There is a spotlight available to learn more about this project.