Pragmatic randomised trial of a 12-week exercise and nutrition program for Aboriginal and Torres Strait Islander women: clinical results immediate post and 3 months follow-up

Abstract

BackgroundAboriginal and Torres Strait Islander women experience higher rates of heart disease and type 2 diabetes than non-Indigenous Australian women. Increasing physical activity, improving diets and losing weight have been shown to reduce cardio metabolic risk. The primary aim was to evaluate the effectiveness of a 12-week structured exercise and nutrition program in a cohort of urban Indigenous Australian women on waist circumference, weight and biomedical markers of metabolic functioning from baseline (T1) to program completion (T2). The secondary aim assessed whether these outcomes were maintained at 3-month follow-up.MethodsOne hundred Aboriginal and/or Torres Strait Islander women aged 18–64 years living in the Adelaide metropolitan area were recruited. The program included two 60-minute group cardiovascular and resistance training classes per week, and four nutrition education workshops. Participants were randomly assigned to an ‘active’ group or ‘waitlisted’ control group. Body weight, height, waist and hip circumference, blood pressure, fasting glucose, fasting insulin, glycated haemoglobin (HbA1C), lipid profile and C-reactive protein (CRP) were assessed at baseline (T1), immediately after the program (T2) and three months post program (T3).ResultsThe active group showed modest reductions in weight and body mass index (BMI). Compared to the waitlisted group, the active group had a statistically significantly change in weight and BMI from baseline assessments; at T2, -1.65 kg and -0.66 kg/m2 and at T3, -2.50 kg and -1.03 kg/m2, respectively. Systolic and diastolic blood pressure also had a statistically significant difference from baseline in the active group compared to the waitlisted group at T2, -1.24 mmHg and -2.46 mmHg and at T3, -4.09 mmHg and -2.17 mmHg, respectively. The findings were independent of the baseline measure of the outcome variable, age, households with children and employment status. Changes in waist circumference and other clinical measures were not significant at T2 or T3. The primary outcome measure, waist circumference, proved problematic to assess reliably. Missing data and participants lost to follow-up were significant.ConclusionsThis 12-week exercise program demonstrated modest reductions in weight, BMI and blood pressure at T2, which improved further at 3-month follow-up (T3). Positive intervention effects were observed despite low attendance at exercise classes. Structured exercise programs implemented in community settings require attention to understanding the barriers to participation for this high risk group.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12610000224022

Interventions with potential to reduce sedentary time in adults: systematic review and meta-analysis

“…Of the 51 included studies (18 480 participants), 44 were RCTs28–70 and seven were cluster RCTs71–77 conducted in Europe (n=25), the USA (n=18), Australia (n=7) and China (n=1). The majority of studies were carried out in a mixed gender population (n=35); 13 studies targeted women only29 42 50 51 56 57 60 61 67 69 71 76 and three studies targeted men only 29 31 44. Most studies included participants aged between 18–60 years (n=44), while seven studies included participants older than 60 years of age 33 35 37 38 48 62 72.…”

“…Three studies employed an intervention specifically to reduce SB,40 44 63 16 studies aimed at increasing PA levels,30 35 36 39 41 46 48 49 55 58–60 64 66 72 78 nine studies combined both approaches of reducing SB and increasing PA levels,32 43 53 62 65 68 70 76 77 one study assessed the effect of a dietary intervention on SB,61 and 22 studies (20 reports) applied a multicomponent lifestyle intervention and observed effects on sedentary behaviour (among other outcomes) 29 33 34 37 38 42 45 47 50–52 54 56 57 67 69 71 73 74 75. Twenty studies offered an alternative intervention,30 36 39–41 45 46 49 52–55 59 61–63 68 72 77 10 studies the usual/routine care,29 37 38 42 50 51 67 71 74 75 seven studies used a waiting list control,29 34 48 64 69 76 78 five studies an attention control,35 44 56 57 60 and control participants of seven studies received no intervention at all 32 33 43 47 58 66 …”

“…Twenty-four studies suggested no evidence of a group difference in SB: 10 lifestyle interventions,29 45 50 52 56 57 67 71 73 75 seven PA interventions,35 36 49 55 58 66 72 six PA/SB interventions,53 62 65 70 76 77 and one SB intervention 44. Four studies—two lifestyle,47 69 one PA/SBs,43 one dietary intervention61—did not conclude on SB outcomes despite assessing SB.…”

“…Studies reported intervention effects on fasting blood glucose concentration,31 42 56 glycosylated haemoglobin levels,37 42 69 triglyceride levels,31 42 56 69 low-density lipoprotein levels,31 42 56 69 total cholesterol,37 42 56 69 high-density lipoprotein levels,31 39 42 56 64 69 blood pressure,32 38 43 57 59 65 70 BMI,29 33 36 37 42 55 56 57 58 59 62 64 69 74 waist circumference,31 42 55 – 59 62 64 69 74 76 percentage body fat42 55 56 58 62 64 and mental health outcomes 29 41 48 49 64 72. Some studies indicated a reduction in these secondary outcomes; however, studies were PA-only or lifestyle interventions and none of the studies were SB-only studies.…”

An innovative team-based weightloss competition to reduce cardiovascular and diabetes risk among Māori and Pacific people: rationale and method for the study and its evaluation

“…Internationally, there have been some interventions for indigenous people, for reducing T2DM prevalence [5,[7][8][9][10][11][12] or that aimed to reduce obesity, CVD and diabetes risk [13][14][15]. These interventions most commonly included exercise [10][11][12][13][14] and/or dietary education [5,9,13,14].…”