Fitness
Improvements
among
children











in
one
Alberta
First
Na7on
BRAID‐Kids
BRAID
Preven1on
of
Obesity
and
Diabet...
BRAID
=
Believing
we
can
Reduce
Aboriginal
Incidence
of
Diabetes
ORIGINAL
BRAID
STUDY
(2003‐2006)
Collabora7on
between
Dri...
SeRng:

DRIFTPILE
CREE
NATION
is
350
kms
northwest
of
Edmonton,
Alberta,
on
the
shores
of
Lesser
Slave
Lake.
Dri;pile
has
...
BRAID‐Kids
STUDY
DESIGN
 BRAID‐Kids
was
based
on
the
Kahnawake
Schools
Diabetes
Preven7on
Program
(KSDPP)
and
the
Sandy
L...
BRAID‐Kids
Hypothesis:
Decoloniza7on
may
enable
First
Na7ons
families
to
avoid
behaviors
that
contribute
to
obesity
and
di...
MIHTATAKAW SIPIY (ELEMENTARY) SCHOOL,DRIFTPILE FIRST NATIONBuilt
in
the
shape
of
an
eagle
feather

RESULTS:
Recruitment:
89
children
and
their
families
were
recruited,
but
this
took
about
2
years.
BRAID‐Kids
Project
Die77...
Baseline clinical, anthropometric for all children measured by BRAID-Kids, N=72aMEASUREMENT RESULTSGender, % female 47.2%M...
Fitness
Tes6ng:
 
20m
Mul7‐stage
Shufle
Run
 beep
test 
(Leger,
1984,
1988)
 
Measures
 maximal
oxygen
uptake ,
which
in...
Baseline fitness percentiles for age and gender, N=90aGender (% female) 45.6%Mean Age (years) 8.0 (range: 4-15 years)Fitne...
Mean
improvements
in
age‐and‐gender
percen1les
for
children

tested
at
~1
year
intervals
(Leger,
1984),
N=19
*
p
<
0.01
fr...
Mean
VO2
Max
values
for
children
tested
at
~1
year
intervals
(n
=
24)

*
p
<
0.01
from
paired
t‐test


RESULTS
AFTER
1
YEAR
We
looked
at
changes
for
children
who
had
repeat
tests

undertaken
a;er
a
~1
year
interval:
 Signific...
FITNESS
ASSESSMENT:
INTERPRETATION
Observed
improvements
in
fitness
are
likely
not
a
direct
result
of
BRAID‐Kids
alone:
 A...
FOOD
FREQUENCY
&
PHYSICAL
ACTIVITY
QUESTIONNAIRE
• 
BRAID‐Kids
u7lized
the
food
frequency
and
physical
ac7vity



ques7onn...
PHYSICAL
ACTIVYTY
Indicators
of
Ac1ve/Inac1ve
Lifestyle
• 
Sum
of
physical
ac7vity:

The
total
number
of
15‐minute
episode...
Television
Viewing
and
Video
Gaming
Values
are
means
(SD).

T‐tests
were
used
to
assess
differences.
Questionnaire response...
Television
Viewing
and
Video
Gaming
Values
are
means
(SD).

T‐tests
were
used
to
assess
differences.
Responses to first and...
Sum
of
Physical
Ac1vity
Frequency
Paradis
G,
Lévesque
L,
Macaulay
AC,
et
al.
Impact
of
a
Diabetes
PrevenAon
Program
on
Bod...
FOOD
FREQUENCY
• 
Nutri7on
data
were
collected
by
a
7‐day
food‐frequency
ques7onnaire



adapted
from
O’Loughlin
et
al.
(2...
Key
Indicators
of
Consump1on
of
High‐sugar
Foods,

High‐fat
Foods,
Fruit
and
Vegetables
†
so;
drink,
candy,
and
sweetened
...
Key
Indicators
of
Consump1on
of
High‐sugar
Foods,

High‐fat
Foods,
Fruit
and
Vegetables
†
so;
drink,
candy,
and
sweetened
...
IN
SUMMARY:
KEY
FINDINGS
Ager
~1
year
interval:
• 
An
increase
in
the
%
of
children
with
diastolic
(but
not
systolic)



h...
POSITIVE
COMMUNITY
ENGAGEMENT/ACTION
• 
Some
families
report
having
changed
their
ea7ng
habits;
• 
BRAID‐Kids
Project
Die7...
Drigpile
Pow
wow

Drigpile
Cadets

Drigpile
Youth
Baseball

Tradi1onal
Hand
Games

Acknowledgements:

Lawson
Founda7on
Alberta
Center
for
Child,
Family
and
Community
Research
Chief
Rose
Laboucan
Health
Dir...
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Presentation to the ACCFCR Showcase, May 22, 2013

  1. 1. Fitness
Improvements
among
children











in
one
Alberta
First
Na7on
BRAID‐Kids
BRAID
Preven1on
of
Obesity
and
Diabetes
in

Children
and
Families
(BRAID‐Kids)
Narrated
by:


















































































Kelli
Campbell,
Research
Assistant
/
Project
Coordinator
Paule=e
Campiou,
Diabetes
Coordinator,
Dri?pile
First
NaAon






































Dr.
Ellen
Toth,
Principal
InvesAgator,
University
of
Alberta

  2. 2. BRAID
=
Believing
we
can
Reduce
Aboriginal
Incidence
of
Diabetes
ORIGINAL
BRAID
STUDY
(2003‐2006)
Collabora7on
between
Dri;pile
and
the
University
of
Alberta.
Screened
the
popula7on
of
Dri;pile
for
undiagnosed
diabetes
(including
children)
Screening
results
in
89
children
and
adolescents:

 

Community
wanted
to
work
on
PREVENTION,
involving
children
and
their
families
Pre-diabetes 27%Probable diabetes 1.2%Overweight 22%Obese 44%
  3. 3. SeRng:

DRIFTPILE
CREE
NATION
is
350
kms
northwest
of
Edmonton,
Alberta,
on
the
shores
of
Lesser
Slave
Lake.
Dri;pile
has
approximately
1600
Band
Members,
of
whom
about
850
live
on
reserve
land.
Dri;pile
is
home
to
approximately
200
children
and
adolescents
ages
5‐17.

  4. 4. BRAID‐Kids
STUDY
DESIGN
 BRAID‐Kids
was
based
on
the
Kahnawake
Schools
Diabetes
Preven7on
Program
(KSDPP)
and
the
Sandy
Lake
diabetes
preven7on
program,
and
used
educa7onal
materials
and
assessment
tools
developed
by
these
programs.

 However,
BRAID‐Kids
planned
to
have
an
improved
study
design
–
Cree
Pride
–
based
on
Pima
Pride:
a
“de‐colonizing”
project
where
exposure
to
Pima
tradi7on
and
culture
improved
diabetes
control
(Narayan,
1998)

  5. 5. BRAID‐Kids
Hypothesis:
Decoloniza7on
may
enable
First
Na7ons
families
to
avoid
behaviors
that
contribute
to
obesity
and
diabetes
risk.

Primary
Outcome:
assess
physical
ac7vity
and
dietary
choices
amongst
children,
by:
 Measuring
clinical,
anthropometric
and
fitness
outcomes
of
par7cipa7ng
children
near
the
beginning
and
end
of
each
school
year;

 Administering
a
food
frequency
and
physical
ac7vity
ques7onnaire;
Interven6on:
 Implemen7ng
an
in‐classroom
diabetes
preven7on
curriculum;
 Implemen7ng
a
tradi7on‐based
 Cree
Pride 
program
aimed
at
parents/guardians/families.

  6. 6. MIHTATAKAW SIPIY (ELEMENTARY) SCHOOL,DRIFTPILE FIRST NATIONBuilt
in
the
shape
of
an
eagle
feather

  7. 7. RESULTS:
Recruitment:
89
children
and
their
families
were
recruited,
but
this
took
about
2
years.
BRAID‐Kids
Project
Die77an
visited
the
school
and
the
community
regularly.
In‐classroom
curriculum
not
fully
implemented.
The

Cree
Pride
interven7on
component
was
developed
as
a
6‐10
session
program
but
it
was
not
implemented,
due
to
compe7ng
ac7vi7es
and
programs
being

carried
out
by
the
community,
the
recrea7on
department,
the
health
center
and
school.


  8. 8. Baseline clinical, anthropometric for all children measured by BRAID-Kids, N=72aMEASUREMENT RESULTSGender, % female 47.2%Mean age, years 7.9 (range: 4-15 years)Fasting glucometer blood glucose, N=57Mean (mmol/L) 5.4 (range: 4.3-7.8)“Possible” diabetesb, # of children (%) 1 (1.8%)“Possible” pre-diabetesc, # of children (%) 7 (12.3%)Body Mass Index (BMI), N=69≥85th-<95th, overweightd, # of children (%) 13 (18.8%)≥95th, obesityd, # of children (%) 35 (50.7%)Central adipositye, N=67, # of children (%) 58 (86.6%)Hypertensionf, N=52, # of children (%) 13 (25.0%)a.
21
children
completed
only
fitness
tes1ng;
b.
fas7ng
blood
glucose
≥7.0
mmol/L;
c.
fas7ng
blood
glucose
6.1‐6.9
mmol/L;
d.
CDC
percen7le
reference
for
age
and
gender;
e.
NHANESIII:
central
adiposity
=
waist
circumference
≥85th
percen7le
for
age
and
gender;
f.
CDC
percen7le
reference
for
age
and
gender,
hypertension:
≥95th
percen7le

  9. 9. Fitness
Tes6ng:
 
20m
Mul7‐stage
Shufle
Run
 beep
test 
(Leger,
1984,
1988)
 
Measures
 maximal
oxygen
uptake ,
which
indicates
aerobic
fitness.

  10. 10. Baseline fitness percentiles for age and gender, N=90aGender (% female) 45.6%Mean Age (years) 8.0 (range: 4-15 years)Fitness: percentile for age and genderb, N=67# of children < 5th percentile (percent) 48 (71.6%)# of children 5th to <10th percentile (percent) 5 (7.5%)# of children 10th to <20th percentile (percent) 5 (7.5%)# of children 20th to <30th percentile (percent) 4 (6.0%)# of children 30th to <40th percentile (percent) 1 (1.5%)# of children 40th to < 50th percentile (percent) 3 (4.5%)# of children 50th to <60th percentile (percent) 1 (1.5%)# of children below 20th percentilec (percent) 53 (79.1%)Baseline
Fitness
results
for
children
who
underwent
fitness

tes1ng
by
BRAID‐Kids
a.
children
under
the
age
of
6
were
excluded,
per
Leger
reference
(Leger,
1984)
b.
(Leger,
1984)
c.
rela7ve
fitness
=
>20th
percen7le
(Downs,
2006)

  11. 11. Mean
improvements
in
age‐and‐gender
percen1les
for
children

tested
at
~1
year
intervals
(Leger,
1984),
N=19
*
p
<
0.01
from
paired
t‐test

  12. 12. Mean
VO2
Max
values
for
children
tested
at
~1
year
intervals
(n
=
24)

*
p
<
0.01
from
paired
t‐test


  13. 13. RESULTS
AFTER
1
YEAR
We
looked
at
changes
for
children
who
had
repeat
tests

undertaken
a;er
a
~1
year
interval:
 Significant
improvements
in
fitness
scores
(in
age‐and‐gender
percen7le
rank
and
VO2
Max)
No
differences
glucose,
weight,
waist
or
BP
except
for
an
increase
in
the
%
of
children
with
diastolic
(but
not
systolic)
hypertension.
BASELINE
RESULTS
Baseline
results
were
once
again
consistent
with
our
very
high
rates
of
overweight
and
obesity
and
very
low
levels
of
fitness
reported
for
some
First
Na7ons
communi7es.


  14. 14. FITNESS
ASSESSMENT:
INTERPRETATION
Observed
improvements
in
fitness
are
likely
not
a
direct
result
of
BRAID‐Kids
alone:
 A
new
physical
educa7on
program
with
a
specific
gym
teacher
at
the
school
was
very
helpful
 Because
of
regular
 beep
tests 
in
gym
class,
children
became
prac7ced
at
test
procedures

 Increased
surveillance
communicated
a
focus
on
fitness
to
children
and
their
families.
 Since
many
Band
Councils
control
their
community’s
educa7on
budget
and
policies,
our
results
may
be
helpful
informa7on
for
Leadership
decision‐making.

  15. 15. FOOD
FREQUENCY
&
PHYSICAL
ACTIVITY
QUESTIONNAIRE
• 
BRAID‐Kids
u7lized
the
food
frequency
and
physical
ac7vity



ques7onnaire
developed
and
used
in
the
Kahnewake
Schools



Diabetes
Preven7on
Project
(KSDPP)
• 
91
children
completed
the
ques7onnaire
at
least
once,
with



assistance
from
a
parent/guardian
• 
29
follow‐up
ques7onnaires
were
completed
a;er
a
~1
year



interval
Jimenez
M,
Receveur
O,
Trifonopoulos
M,
Kuhnlein
H,
Paradis
G,
Macaulay
AC.
EvaluaAon
of
dietary
change

among

children
(grades
4–6)
from
the
Kahnawake
Schools
Diabetes
PrevenAon
Project.
J
Am
Diet
Assoc.,
2003;103:1191–1194.

  16. 16. PHYSICAL
ACTIVYTY
Indicators
of
Ac1ve/Inac1ve
Lifestyle
• 
Sum
of
physical
ac7vity:

The
total
number
of
15‐minute
episodes
of
25
sports

and
other
physical
ac7vi7es
during
and
outside
of


school
hours.
• 
Frequency
of
sedentary
ac7vi7es:


Television
watching
and
video/internet
gaming
on


weekdays
and
on
Saturdays.
Sallis
J,
Strikmiller
P,
Harsha
D,
et
al.
ValidaAon
of
interviewer
and
self‐administered
physical
acAvity
checklists
for
fi?h
grade
students.
Med
Sci
Sports
Exerc.
1996;28:840–851
Paradis
G,
Lévesque
L,
Macaulay
AC,
et
al.
Impact
of
a
Diabetes
PrevenAon
Program
on
Body
Size,
Physical
AcAvity,
and
Diet
Among
Kanienkehá:ka
(Mohawk)
Children
6
to
11
Years
Old:
8‐Year
Results
From
the
Kahnawake
Schools
Diabetes
PrevenAon
Project.
Pediatrics,2005;115:333‐339.

  17. 17. Television
Viewing
and
Video
Gaming
Values
are
means
(SD).

T‐tests
were
used
to
assess
differences.
Questionnaire responses by gender (N = 91)Females (SD) Males (SD) p-valueTV watching on school days 2.6 (1.1) 2.7 (1.3) 0.767Video/internet gaming on schooldays2.4 (1.0) 2.1 (0.9) 0.224TV watching Saturday morning 2.6 (0.9) 2.4 (0.9) 0.203TV watching Saturday afternoon 2.9 (0.8) 2.7 (1.0) 0.285Video/internet gaming Saturdaymorning3.3 (0.7) 2.8 (1.1) 0.019Video/internet gaming Saturdayafternoon3.1 (0.8) 2.7 (1.0) 0.044
  18. 18. Television
Viewing
and
Video
Gaming
Values
are
means
(SD).

T‐tests
were
used
to
assess
differences.
Responses to first and second questionnaires (N = 29)1st Questionnaire(SD)2nd Questionnaire(SD)p-valueTV watching on school days 2.7 (1.1) 2.5 (1.2) 0.537Video/internet gaming on schooldays2.2 (1.0) 2.2 (1.0) 0.981TV watching Saturday morning 2.6 (0.8) 3.1 (0.9) 0.025TV watching Saturday afternoon 3.0 (0.7) 2.9 (0.8) 0.489Video/internet gaming Saturdaymorning3.2 (0.8) 3.5 (0.7) 0.199Video/internet gaming Saturdayafternoon3.1 (0.9) 3.2 (0.8) 0.621
  19. 19. Sum
of
Physical
Ac1vity
Frequency
Paradis
G,
Lévesque
L,
Macaulay
AC,
et
al.
Impact
of
a
Diabetes
PrevenAon
Program
on
Body
Size,
Physical
AcAvity,
and
Diet
Among
Kanienkehá:ka
(Mohawk)
Children
6
to
11
Years
Old:
8‐Year
Results
From
the
Kahnawake
Schools
Diabetes
PrevenAon
Project.
Pediatrics,2005;115:333‐339.
Values
are
means
(SD).

T‐tests
were
used
to
assess
differences.
Questionnaire responses by gender (N = 91)Females (SD) Males (SD) p-valueTotal physical activityin past 7 days32.0 (17.9) 24.2 (17.7) 0.04Responses to first and second questionnaires (N = 29 )1st Questionnaire(SD)2nd Questionnaire(SD)p-valueTotal physical activityin past 7 days35.7 (3.8) 21.3 (2.4) <0.001
  20. 20. FOOD
FREQUENCY
• 
Nutri7on
data
were
collected
by
a
7‐day
food‐frequency
ques7onnaire



adapted
from
O’Loughlin
et
al.
(2000)
• 
Ques7ons
asked
how
o;en
children
ate
51
different
foods
• 
Jimenez
et
al.
(2003)
developed
three
3‐item
subscales
of
indicators
of:
• 
key
high‐sugar
food
consump7on
(so;
drink,
candy,
and



sugared
cereal)
• 
key
high‐fat
food
consump7on
(hot
dogs,
fries,
chips)
• 
fruit
and
vegetable
consump7on
(including
fruit
and



vegetable
juices)
O’Loughlin
J,
Paradis
G,
Renaud
L,
Meshefedjian
G,
Gray‐Donald
K.
Prevalence
and
correlates
of
overweight
among
elementary
schoolchildren
in
mulAethnic,
low
income,
inner‐city
neighbourhoods
in
Montreal,
Canada.
Ann
Epidemiol.
2000;8:422–432
Jimenez
M,
Receveur
O,
Trifonopoulos
M,
Kuhnlein
H,
Paradis
G,
Macaulay
AC.
EvaluaAon
of
dietary
change
among
children
(grades
4–6)
from
the
Kahnawake
Schools
Diabetes
PrevenAon
Project.
J
Am
Diet
Assoc.
2003;103:1191–1194

  21. 21. Key
Indicators
of
Consump1on
of
High‐sugar
Foods,

High‐fat
Foods,
Fruit
and
Vegetables
†
so;
drink,
candy,
and
sweetened
cereal
§
hot
dogs,
fries,
chips

‡
includes
fruit
and
vegetable
juices
Values
are
means
(SD)
scored
from
1
(did
not
eat)
to
5
(6
days
to
everyday).

Paired
t‐tests
were
used
to
assess
differences.
Seven-day food frequency responses by gender (N = 90)Females (SD) Males (SD) p-valueKey high-sugar foodconsumption†4.0 (1.2) 4.2 (1.4) 0.395Key high-fat foodconsumption§3.5 (1.3) 3.5 (1.1) 0.967Fruit and vegetableconsumption‡4.9 (0.5) 4.9 (0.4) 0.948
  22. 22. Key
Indicators
of
Consump1on
of
High‐sugar
Foods,

High‐fat
Foods,
Fruit
and
Vegetables
†
so;
drink,
candy,
and
sweetened
cereal
§
hot
dogs,
fries,
chips

‡
includes
fruit
and
vegetable
juices
Values
are
means
(SD)
scored
from
1
(did
not
eat)
to
5
(6
days
to
everyday).

Paired
t‐tests
were
used
to
assess
differences.
First and second seven-day food frequency responses (N = 27)1st Questionnaire(SD)2nd Questionnaire(SD)p-valueKey high-sugar foodconsumption†4.0 (1.2) 4.1 (1.2) 0.780Key high-fat foodconsumption§3.1 (1.1) 3.4 (1.1) 0.188Fruit and vegetableconsumption‡4.9 (0.2) 4.7 (0.6) 0.019
  23. 23. IN
SUMMARY:
KEY
FINDINGS
Ager
~1
year
interval:
• 
An
increase
in
the
%
of
children
with
diastolic
(but
not
systolic)



hypertension.
• 
Improvement
in
fitness
scores.
• 
Sum
physical
ac7vity
decreased.


This
contradicts
the
observed
improvements
in
fitness
scores.
• Television
watching
on
Saturday
mornings
increased.
• Fruit
and
vegetable
consump7on
decreased.
• No
change
in
high‐sugar
and
high‐fat
food
consump7on.

  24. 24. POSITIVE
COMMUNITY
ENGAGEMENT/ACTION
• 
Some
families
report
having
changed
their
ea7ng
habits;
• 
BRAID‐Kids
Project
Die77an
visi7ng
Dri;pile
regularly;
• 
Full‐7me
school

gym
teacher;
• 
Numerous
community
efforts
at
promo7ng
preven7on
and
healthy
living;
and,
• 
CREE
PRIDE

  25. 25. Drigpile
Pow
wow

  26. 26. Drigpile
Cadets

  27. 27. Drigpile
Youth
Baseball

  28. 28. Tradi1onal
Hand
Games

  29. 29. Acknowledgements:

Lawson
Founda7on
Alberta
Center
for
Child,
Family
and
Community
Research
Chief
Rose
Laboucan
Health
Director
Florence
Willier
Research
Assistants:
Trina
Scof
Tessirae
Sasakamoose
Priscilla
Lalonde
U
of
A
support:
Kelli
Campbell

Die77an:
Karie
Quinn


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