Project Title: Co-creation of a strengths-based approach to improve cardiometabolic health: a community-based and Indigenous-led healthy lifestyle intervention

1. Henry P. H. Lai, MSc

2. Acknowledgements
We acknowledge that we are on the tradi1onal, ancestral,
and unceded territory of the xʷməθkʷəy̓əm (Musqueam)
people on which UBC - Vancouver campus resides.

3. Culturally Safe Knowledge Translation Practices
in Public Health Interventions
Thesis: Co-Creation of a Strengths-Based Approach to Improve Cardiometabolic Health: A
Community-Based and Indigenous-Led Healthy Lifestyle Intervention
Henry P. H. Lai MSc (He, Him, His)
Killam Laureate 2020
Cardiovascular Physiology and Rehabilitation Laboratory
Physical Activity Promotion and Chronic Disease Prevention Unit
The University of British Columbia | Unceded Musqueam Territory
Rm. 206, 2259 Lower Mall Research Station, Vancouver, BC V6T 1Z4
Email: henry.lai@ubc.ca
Website: http://www.healthandphysicalactivity.com

4. Culturally Safe Knowledge Transla<on Prac<ces
in Public Health Interven<ons
NCCPH Student Award Presenta1on
Indigenous Studies in Kinesiology
Indigenous Physical
Activity and Cultural Circle

5. Purpose
To assess the impact of a community-based
and Indigenous led approach in improving
cardiometabolic-related health and fitness
outcomes and reducing sedentary ac:vity
:me in Indigenous adults living in a rural
and remote community.

6. Introduc3on
• Cardiometabolic syndrome is a cluster of metabolic abnormalities that are
risk factors for cardiovascular disease (Kirk & Klein, 2009)
• Cardiorespiratory fitness (maximal aerobic power; strong predictor of
cardiometabolic health) is declining in Canadian Indigenous populations
(Hedayat et al., 2018)
• Greater prevalence of select chronic conditions among Indigenous peoples
(Foulds et al., 2011; 2012)

7. Introduction
• Health benefits of physical ac:vity: what is the minimum threshold?
• InternaFonal guidelines: 150 min/week (30 min/day) of MVPA in bouts of ≥10 min
(Tremblay et al., 2011)
• NO clear threshold for benefits
• Health benefits can be gained from adhering to guidelines that are well below
current recommendaFons
• Evidence: SystemaFc review of current systemaFc reviews, ACSM PosiFon Stand
(Warburton & Bredin, 2017; ACSM, 2011)

8. Introduction
• Health benefits of physical activity: what is the minimum threshold?
“More is better, but every little bit counts.”
(Warburton & Bredin, 2017)

9. “Sometimes promoting health
means talking about things
that don’t directly seem to
impact health.”
- Dr. Andrea Bundon, UBC

10. Cultural Safety
• Current evidence calls for more culturally relevant and safe
approaches: strengths-based approaches
(Pelle:er et al., 2017)
• Need to learn about the strengths, goals, and aspira:ons of
Indigenous communi:es
(Warburton & Bredin, 2017)
• However, rela:vely few inves:ga:ons consider the aspira:ons of the
community and/or include Indigenous leaders in the design and
implementa:on of the interven:on
(Anand et al., 2007)

11. Purpose
To assess the impact of a community-based
and Indigenous led approach in improving
cardiometabolic-related health and fitness
outcomes and reducing sedentary activity
time in Indigenous adults living in a rural
and remote community.

12. Hypotheses
1) Participants would exhibit significant and clinically relevant
improvements in health-related physical fitness measures.
2) The greatest relative changes in health markers would be seen in
those with the lowest physical activity and/or fitness levels at
baseline.
3) Participants would exhibit significant reductions in sedentary
activity time.
4) The greatest reductions in sedentary activity time would be seen
in those exhibiting the greatest increase in MVPA time.

13. 3-month healthy lifestyle intervention

14. Exercise
Program
Individualized Exercise
Prescriptions
Sharing
Circles
Healthy Lifestyle
Behaviours
+
Methodology
3-Month Intervention

15. Photo Credit: Indigenous Studies in Kinesiology, 2018.

18. “Community Voice”
If you were to design a healthy lifestyle
program that could reduce diseases (e.g.,
heart disease, diabetes) for your
community, what would it look like?
Word cloud visualization generated on UBC Qualtrics

19. “Community Voice”
• The following thoughts were voiced by Indigenous community members:
There is strong support for Elders
to be program champions
There is a need to groom
young champions and role
models for community-
based initiatives.
Elders can teach ‘tips and tricks”
to youth and children, allowing
for the intergenerational sharing
of knowledge.
There is strong support for
Elder-only acCviCes in
healthy lifestyle behaviours

20. A Wholistic Approach = Balanced Sense of Wellbeing
This infographic was designed under the guidance of traditional Indigenous Elders

21. Exercise
Program
Individualized Exercise
Prescriptions
Sharing
Circles
Healthy Lifestyle
Behaviours
+
Methodology
3-Month Intervention

22. Individualized
Exercise Prescriptions
Work towards 150
min/week of moderate-to-
vigorous intensity ac:vity

23. Lai et al., 2019; Warburton, D.E.; Nicole, C.W.; Bredin, S.S. Prescribing exercise as a preventive therapy. CMAJ 2006, 174, 961–974
HRR: heart rate reserve; RPE: rating of perceived exertion (ten-point scale)

24. Sharing
Circles
Healthy Lifestyle
Behaviours
+
Methodology
3-Month Interven1on
Exercise
Program
Individualized Exercise
Prescriptions

25. 1 2 3
Co-Creation
Design of Topics
Data Analysis:
Affinity Mapping
Sharing Circle
Topics

26. 1. Co-Crea*on Design of Topics
(Sanders & Stappers, 2008)

27. 2. Affinity Mapping of Co-Creation Responses
(Hanington & Martin, 2012)

28. 3. Sharing Circle Topics

29. Exercise
Program
Individualized Exercise
Prescriptions
Sharing
Circles
Healthy Lifestyle
Behaviours
+
Methodology
3-Month Interven1on

30. Outcome Measures
Fitness-Related
Outcomes
• Cardiorespiratory
• Musculoskeletal
• Anthropometry
Physical AcDvity and
Sedentary Behaviour
• Accelerometry
• Self-Report
+

31. Outcome
Measures
Cardiorespiratory fitness
(predicted VO2max; 6-minute walk test)
Musculoskeletal:
• Grip strength
• Sit-and-reach
(CPAFLA norms)
Anthropometry:
• Weight, height, BMI
• Waist circumference
• % body fat
Actigraph wGT3X-BT accelerometer
(total time, frequency)
• Leisure Time Activity Survey
• Sedentary Behaviour
Questionnaire
Godin & Shephard, 1985;
Rosenberg et al., 2010.
VO2max (mL/kg/min) = 70.161 + (0.023 × distance (m)) - (0.276 × weight (kg)) - (6.79
× sex, where m = 0, f = 1) - (0.193 × resting heart rate (bpm)) - (0.191 × age (year)).
Burr et al., 2011.
Payne et al., 2000.

32. Fitness
Outcomes
↑ cardiorespiratory fitness
↓ resDng heart rate
↓ resDng blood pressure
Photo Credit: Indigenous Studies in Kinesiology, 2018.

33. Least Fit = Most Benefits
p < 0.05, r = -0.76

34. Least Fit = Most Benefits
p < 0.05, r = -0.76

35. Least Fit = Most Benefits
Least Fit
Moderately Unfit
Moderately Fit
p < 0.05, r = -0.76

36. Least Fit = Most Benefits
13%
3%
5%
* p < 0.05
n = 5
n = 5
n = 5

37. MVPA and VO2max
p < 0.05, r = 0.42

38. Success?
• Exercise adherence rate
increased (93%)
• 75% completion rate
(15/20 participants)
Photo Credit: Indigenous Studies in Kinesiology, 2018.

39. 30 Minute MVPA ↑ by 10 Minutes
↑ 10 minutes per day
*p < 0.05

40. “Increasing the amount of physical
activity by 10 minutes each day might
not seem a lot, but it re;lects the 7%
increase in cardiorespiratory ;itness.”

41. Health benefits can be gained
by adhering to physical
activity guidelines well below
current recommendations.
(Warburton & Bredin, 2017)

42. Healthy Lifestyle
Behaviours
↑ MVPA 'me
↓ Sedentary ac'vity 'me
Photo Credit: Indigenous Studies in Kinesiology, 2018.

43. ↓ Longer Sedentary Bouts
*p < 0.05

44. ↓ Screen Time Ac<vity
*p < 0.05

45. The strongest association
(p = 0.03, r = -0.67) was
observed between reduced
computer/video game
screen time and increased
accelerometry-measured
MVPA minutes
Implications for the
effectiveness of a
community-based,
designed, and led healthy
lifestyle intervention?
p < 0.05, r = -0.67

46. “Every little bit counts!”
“Sit less, walk more!”
(Warburton & Bredin, 2017)

47. Cultural Safety: A Strengths-Based Approach
A strengths-based approach considers:
1. The growth and safety of the community as a whole
2. Innate strengths and aspira:ons unique to the community
3. The tradi:onal, historical, and cultural perspec:ves of teaching
and learning unique to diverse Indigenous communi:es in Canada
(Warburton & Bredin, 2019)

48. Effective
Health
Promotion
Effective
Knowledge
Translation
=

49. Knowledge Translation
“a dynamic and iterative process that includes
synthesis, dissemination, exchange and
ethically-sound application of knowledge to
improve the health of Canadians, provide
more effective health services and products,
and strengthen the health care system.”
Canadian Institutes of Health Research

50. “Sometimes promoting health
means talking about things
that don’t directly seem to
impact health.”
(KIN 464 Introduction, slide 13)

51. Food for thought?
“a dynamic and iterative process that includes
co-creation, sharing, exchange and culturally-
safe application of knowledge to improve
the health of Canadians, provide more
effective health services and products, and
strengthen the health care system.”

52. Photo Credit: Indigenous Studies in Kinesiology, 2018.
Summary 1. Generic physical ac0vity
guidelines should not be
applied within Indigenous
communi0es

53. Photo Credit: Indigenous Studies in Kinesiology, 2018.
Summary 1. Generic physical activity
guidelines should not be
applied within Indigenous
communities
2. Culturally relevant and safe
approaches require
extensive community
engagement

54. Photo Credit: Indigenous Studies in Kinesiology, 2018.
Summary 1. Generic physical activity
guidelines should not be
applied within Indigenous
communities
2. Culturally relevant and safe
approaches require
extensive community
engagement
3. Sharing circles draw upon
the traditional, historical,
and cultural perspectives
unique to the community

55. References
For more informa+on, please visit:
h4ps://open.library.ubc.ca/cIRcle/collec+ons/ubctheses/24/items/1.0390348
UBC Thesis:
CO-CREATION OF A STRENGTHS-BASED APPROACH TO IMPROVE
CARDIOMETABOLIC HEALTH: A COMMUNITY-BASED AND INDIGENOUS LED
HEALTHY LIFESTYLE INTERVENTION

56. Thank you
Kwuks chemx
Hych’ka
Miigwetch