Fitness Improvements among children in one Alberta First Nation

BRAID-KidsBRAID Prevention of Obesity and Diabetes in

Children and Families (BRAID-Kids)

Paulette Campiou, Diabetes Coordinator, Driftpile First Nation Dr. Ellen Toth, Principal Investigator, University of Alberta

BRAID = Believing we can Reduce Aboriginal Incidence of Diabetes

ORIGINAL BRAID STUDY (2003-2006)

Collaboration between Driftpile and the University of Alberta.

Screened the population of Driftpile 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%

Setting:

DRIFTPILE CREE NATION is 350 kms northwest of Edmonton, Alberta, on the shores of Lesser Slave Lake

Driftpile has approximately 1600 Band Members, of whom about 850 live on reserve land.

Driftpile is home to approximately 200 children and adolescents ages 5-17.

BRAID-Kids STUDY DESIGN

BRAID-Kids was based on the Kahnawake Schools Diabetes Prevention Program (KSDPP) and the Sandy Lake diabetes prevention program, and used educational 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 tradition and culture improved diabetes control (Narayan, 1998)

BRAID-Kids & Cree Pride

BRAID (original study)

Pima Action / Pima Pride

KSDPP (Kahnawake) Sandy Lake

DPP

BRAID-Kids

Hypothesis: Decolonization may enable First Nations families to avoid behaviors that contribute to obesity and diabetes risk.

Primary Outcome: assess physical activity and dietary choices amongst children, by:

Measuring clinical, anthropometric and fitness outcomes of participating children near the beginning and end of each school year;

Administering a food frequency and physical activity questionnaire

Implementing an in-classroom diabetes prevention curriculum;

Implementing a tradition-based “Cree Pride” program aimed at parents/guardians/families.

Mihtatakaw Sipiy (ELEMENTARY) School, DRIFTPILE FIRST NATION

Built in the shape of an eagle feather

RESULTS:

Recruitment: 89 children and their families were recruited, but this took 2 years

Fitness assessments and risk assessments were conducted near the beginning and end of the school year.

BRAID-Kids Project Dietitian visited the school and the community regularly

The Cree Pride intervention component was developed as 6-10 sessions but it was not implemented, due to competing activities and programs being carried out by the community, the recreation department, the health center and school;

.

Baseline clinical, anthropometric for all children measured by BRAID-Kids, N=89

MEASUREMENT RESULTS

Gender, % female 42 (47.2%)

Mean age, years 8.2 (range: 4-15)

Fasting glucometer blood glucose, N=59

Mean (mmol/L) 5.4 (range: 4.3-7.8)

“Possible” diabetesa, # of children (%) 1 (1.7%)“Possible” pre-diabetesb, # of children (%) 7 (11.9%)

Body Mass Index (BMI), N=87:

≥85th-<95th, overweightc, # of children (%) 18 (20.7%)

≥95th, obesityc, # of children (%) 43 (49.4%)

Central adiposityd, N=88, # of children (%) 74 (84.1%)Hypertensione, N=60, # of children (%) 14 (23.3%)

a. fasting blood glucose ≥7.0 mmol/L; b. fasting blood glucose 6.1-6.9 mmol/L; c. CDC percentile reference for age and gender; d. NHANESIII: central adiposity = waist circumference ≥85th percentile for age and gender; e. CDC percentile reference for age and gender, hypertension: ≥95th percentile;

Fitness Testing:

20m Multi-stage Shuttle Run “beep test” (Leger, 1984, 1988) Measures “maximal oxygen uptake”, which indicates aerobic fitness.

.

Fitness percentiles for age and gender, N=86a

Gender (% female) 37 (43.0%)

Mean Age (years) 9

Fitness: percentile for age and genderb, N = 86

# of children < 5th percentile (percent) 58 (67.4%)

# of children 5th to <10th percentile (percent) 8 (9.3%)

# of children 10th to <20th percentile (percent) 9 (10.5%)

# of children 20th to <30th percentile (percent) 5 (5.8%)

# of children 30th to <40th percentile (percent) 1 (1.2%)

# of children 40th to < 50th percentile (percent) 3 (3.5%)

# of children 50th to <60th percentile (percent) 2 (2.3%)

# of children below 20th percentilec (percent) 75 (87.2%)

Baseline Fitness results for children who underwent fitness testing by BRAID-Kids

a. children under the age of 6 were excluded, per Leger reference (Leger, 1984)b. (Leger, 1984)c. relative fitness = >20th percentile (Downs, 2006)

RESULTS AFTER ONE YEAR

We looked at changes for children who had repeat tests undertaken after a 1 year interval:

Significant improvements in fitness scores (in age-and- gender percentile rank and VO2 Max)

No differences in 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 Nations communities.

Mean improvements in age-and-gender percentiles for childrentested at 1 year intervals (Leger, 1984), N=19

* p < 0.01 from paired t-test

Mean VO2 Max values for children tested at 1 yearintervals (n = 24)

* p < 0.01 from paired t-test

INTERPRETATION

Observed improvements in fitness are likely not a direct result of BRAID- Kids alone:

A new physical education program with a specific gym teacher at the school was very helpful

Because of regular “beep tests” in gym class, children became practiced at test procedures

Increased surveillance communicated a focus on fitness to children and their families.

Since many Band Councils control their community’s education budget and policies, our results may be helpful information for Leadership decision-making.

IN SUMMARY

Positive things are happening:

Some families report having changed their eating habits.

BRAID-Kids Project Dietitian visiting Driftpile regularly.

Full-time school gym teacher.

numerous community efforts at promoting prevention and healthy living; and,

CREE PRIDE

Driftpile Cadets

Driftpile Youth Baseball

Traditional Hand Games

Acknowledgements:

Lawson Foundation

Alberta Center for Child Family and Community Research

Chief Rose LaboucanHealth Director Florence Willier

Research assistants:Trina ScottTessirae SasakamoosePriscilla Lalonde

U of A support: Kelli Ralph Campbell

Dietitian: Kari Quinn