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