# Exercise as it relates to Disease/Usefulness and effects of a healthy lifestyle program in a remote Aboriginal community

This Wikibooks page is an overview of the journal article 'Effectiveness of a community-directed ‘healthy lifestyle’ program in a remote Australian Aboriginal community by Rowley and colleagues published in 2000.

## What is the background to this research?

Aboriginal health in Australia is at a much lower standard than that of the general population. As compared to non-indigenous Australians, Aboriginal people are:
* three times more likely to develop diabetes.
* three times more likely to have major coronary event
* 1.5 times more likely to be overweight or obese
* expected to die 10.3 years earlier than non-Indigenous Australians
These statistics have made health in Aboriginal communities a priority. Despite this, mainstream public health campaigns often fail to be effective in these communities. This may be due to language barriers, cultural differences or lack of mainstream media in remote communities. As a result, targeted lifestyle programs tailored for specific communities have been introduced. There is also a large need for programs such as these as many health issues in Aboriginal communities are caused by changeable lifestyle factors. These include tobacco use, alcohol consumption, diet and physical activity. Healthy lifestyle programs target a specific community in a tone they will be receptive and aim to positively influence lifestyle factors for better health.

## Where is the research from?

This study introduced a healthy lifestyle program in Looma, a remote Aboriginal community in North Western Australia. The research was conducted by researchers at Monash University from 1993–1999 and was approved by the Deakin University Ethics Committee. Professor Kevin Rowley was the leading researcher for the study. He now is an academic at the University of Melbourne and has been involved in over 100 published journal articles over the past 20 years, making him an experienced researcher . Aside from the academics at Monash University, Gwyneth White of the Derby Aboriginal Health Service was also involved in the study. She carried out the delivery of the program and lived in Derby. This is an insightful inclusion to the study as many Aboriginal communities are often wary of outside help and are more willing to work with those living in their community.
The Australian and New Zealand Journal of Public Health is a reputable journal and everything included is subject to regular refereeing procedures. The journal falls under the jurisdiction of the Public Health Association of Australia and does not receive corporate funding.

## What kind of research was this?

This was a non-randomised, non-controlled longitudinal study. Quantitative data collected included height, weight, fasting glucose levels, insulin concentrations and plasma triglyceride levels of 96 overweight and diabetic volunteers. The qualitative data was collected via cross sectional questionnaires from the 96 individuals and the greater community.
The reliability of the data is questionable as the group of 96 individuals taking part in the interventions were self-selected. Also, physical activity levels and diet were self-reported via questionnaires which can skew data to reflect participants more favourably than the true results.
Data was analysed using repeated measures ANOVA and univariate F statistics to compare changes in the intervention and non-intervention group. Interactions were considered statistically significant with a p-value of <0.1, due to the low numbers and statistical power.

## What did the research involve?

96 overweight and diabetic volunteers were given a range of healthy lifestyle interventions including:
* Education sessions
* Healthy cooking classes
* Regular physical activity groups
* Store tours to educate on nutritional labelling
Volunteers were screened over 24 months. A group of non intervention volunteers were also screened for comparison.

## What were the basic results?

As shown below, the program did not have significantly positive effects in any area.
Table 1a: BMI Measures of Intervention and Non-Intervention Groups :
| | Intervention | Non-Intervention |
| Baseline | 28.5 | 28.9 |
| 1 Years | 28.0 | 28.7 |
| 2 Years | 28.5 | 29.1 |
BMI decreased slightly before returning to baseline.
Table 1a: Fasting Glucose Measures of Intervention and Non-Intervention Groups :
| | Intervention | Non-Intervention |
| Baseline | 7.7 | 8.3 |
| 1 Years | 8.0 | 8.2 |
| 2 Years | 7.0 | 8.4 |
Fasting glucose increased before decreasing slightly.
Table 1a: Fasting Insulin Measures of Intervention and Non-Intervention Groups :
| | Intervention | Non-Intervention |
| Baseline | 23.7 | 22.1 |
| 1 Years | 20.4 | 24.5 |
| 2 Years | 19.0 | 25.3 |
Fasting insulin showed the best improvement decreasing to 4.7mlU/L after the two year program.
Table 1a: Plasma Triglyceride Measures of Intervention and Non-Intervention Groups :
| | Intervention | Non-Intervention |
| Baseline | 2.2 | 2.0 |
| 1 Years | 2.4 | 2.1 |
| 2 Years | 2.0 | 2.5 |
Plasma triglycerides increased after 12 months before decreasing to just below baseline after two years.

## What conclusions can we take from this research?

The healthy lifestyle program did not have a significant effect on any area except fasting insulin. This study shows that more research must be done in the area of lifestyle programs in Aboriginal communities to find a delivery method and interventions that will result in better health for Indigenous Australians.

## Practical advice

New research must be conducted into the area exploring different delivery methods and interventions for long lasting results. The integration of input from community Elders would be a favourable consideration in future research. Randomised, non-controlled studies would also yield more reliable results.

## Further information/resources

For further information on healthy lifestyle programs, click the following links:
* Factors contributing to Indigenous health: http://www.healthinfonet.ecu.edu.au/states-territories-home/wa/reviews/our-review/health-risk-factors
* Evidence of effective interventions: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-oatsih-pubs-evidence
* Aboriginal Health programs: http://www.healthinfonet.ecu.edu.au/key-resources/programs-projects
* Background on healthy lifestyle programs in Aboriginal communities: http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2012/ctgc-rs09.pdf

## References

* 1 2 3 Australian bureau of statistics. (2014). Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012-13 - Australia. Retrieved 8 September 2016, from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?
* ↑ Australian Institute of Health and Welfare. (June 2008). Cardiovascular disease and its associated risk factors in Aboriginal and Torres Strait Islander peoples 2004 05, CVD 29, Retrieved 8 September 2016, from http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442455071
* ↑ Authoritative information and statistics to promote better health and wellbeing. (2016). Life expectancy. Retrieved 9 September 2016, fromhttp://www.aihw.gov.au/deaths/life-expectancy/
* 1 2 3 4 5 6 7 Rowley et al. (2000). Effectiveness of a community-directed ‘healthy lifestyle’ program in a remote Australian Aboriginal community. Australian and New Zealand Journal of Public Health, 25(2). Retrieved 8 September 2016)
* ↑ University of Melbourne. (2016). Dr. Kevin Rowley. Retrieved 20 September 2016, from http://findanexpert.unimelb.edu.au/display/person12872#tab-publications
* ↑ Attwood B. Australian Humanities Review. (April 1996). The Past as Future: Aborigines, Australia and the (dis)course of History. Retrieved 20 September 2016 fromhttp://australianhumanitiesreview.org/1996/04/01/the-past-as-future-aborigines-australia-and-the-discourse-of-history/.
* ↑ Australian and New Zealand Journal of Public Health. (2016). ANZJPH. Retrieved on 20 September 2016 from https://www.phaa.net.au/advocacy-policy/anzjph/anzjph