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Australian Indigenous HealthBulletin
 
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spacing1Review of physical activity among Indigenous Australians

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Preface

This Plain language review of physical activity among Indigenous Australians is based on the Review of physical activity among Indigenous Australians (2013) by Caitlin Gray, Rona Macniven and Neil Thomson

Introduction

Physical activity

Physical activity involves movement of the skeletal muscles (muscles attached to the skeleton) of the body and uses energy [1]. Being physically active can occur anywhere: at work, at play, doing chores, travelling. It can be a planned activity (such as organised sport) or unplanned (running to catch the bus). Regular, moderate physical activity (see Box 1) can help to [1]:

Physical inactivity

Physical inactivity (not getting enough moderate or vigorous activity) is a modifiable risk factor1 for some chronic diseases and health conditions [2]. Being physically active can help in the prevention, management and treatment of some diseases or health conditions [3][4][5][6] including:

Box 1: Levels of physical activity

Sedentary behaviour means doing little or no physical activity.

Moderate activities cause you to breathe heavier and your heart to beat faster, but you can still talk while you are doing them. Examples of moderate activity are: brisk walking, riding a bike, swimming, golf, gardening, social tennis, house cleaning.

Vigorous activities take more effort and make you 'huff and puff'. Examples of vigorous activity are: jogging, most organised sports, fast cycling, and activities that include digging, lifting or carrying.

Physical inactivity is the second leading modifiable risk factor that contributes to the loss of healthy life (the disease burden) in Australia [7], with smoking as the leading cause. Physical inactivity is the third leading cause of disease burden for Indigenous people [8], after smoking and being overweight or obese. The effect of physical inactivity on the health of Indigenous2 people is greater than it is for other Australians.

In Australia, the overall costs of physical inactivity to health and wellbeing are high [9]. Costs are measured in terms of medical expenses and time lost from work due to illness or injury or death. There are no specific estimates of the cost for Indigenous people, but it is likely to be high.

What is known about physical activity and Indigenous people – how history influences the present

Physical activity levels among Indigenous peoples in Australia have changed over time. For some Indigenous peoples, their once active lifestyles changed with European colonisation. Their lifestyle may once have included [10][11][12][13]:

The farming practices that were introduced by the white settlers prevented many Indigenous peoples from having access to the land [11]. Some Indigenous peoples were moved to missions or towns and had to rely on food hand-outs by the Europeans. Physical activity levels and food quality were greatly reduced by these changes to the lifestyles of these Indigenous people [13]. Physical activity was no longer a major part of everyday life.

Reduction in the physical activity levels of Indigenous people over time (particularly in the last half century or so), together with poor nutrition has contributed to an increase in the number of people who have chronic diseases [13] such as:

For some Indigenous people, the concept of physical activity is not thought of in the same way as by other Australians [14][15]. The activities that made up the traditional Indigenous lifestyle, such as hunting, gathering, and participation in other customs and traditions, were important and linked many different aspects of life [15] such as:

These historical beliefs form part of the values of many Indigenous people today. Engaging in an individual physical activity to benefit only oneself, away from family or community, may be seen as inappropriate or selfish [15].

Physical activity was, and is, not seen by many Indigenous people as a separate, measurable activity in the same way as it is for non-Indigenous people [15]. Measuring levels and the types of physical activity by Indigenous people may be affected by:

Self-reported measures of physical activity could inaccurately record the level of physical activity for Indigenous people, because the westernised definition and measurements of physical activity used may differ from Indigenous concepts.

Similarly, interventions targeting physical activity for Indigenous people may fail if they are based on westernised approaches to physical activity rather than taking account of Indigenous ideas of what constitutes physical activity.

What are the Australian physical activity guidelines?

The National Physical Activity Guidelines for Australians recommend that all Australians do some physical activity on most, preferably all, days of the week [16][17]. Guidelines for physical activity in Australia were developed by the Australian Department of Health and Ageing, and outline the least amount of physical activity required in order to be healthy.

The benefits of doing regular physical activity and limiting sedentary behaviour include helping you to [18][19]:

The amount of physical activity recommended is different for children and adults [17]:

Physical activity can be done as a large block of activity (do one 30 minute session) or in small blocks of activity throughout the day (do three 10 minute sessions) [17].

The recommendations also include not spending more than one hour at a time of sedentary behaviour, with the exception of sleeping.

Box 2: Physical activity guidelines [17]

Very young children

Birth to 1 year

  • From birth, babies should be as active as possible, particularly play on the floor.
  • Once infants are moving around they should be encouraged to be as active as possible in a safe play area where they can be seen by a caregiver.
  • Unless they are sleeping, infants should always be active and not spend more than one hour at a time without being active.

1 to 5 years

  • Toddlers (1 to 3 years) and pre-schoolers (3 to 5 years) should be active every day for at least three hours, spread across the day.
  • Active play is the best way for young children to be physically active.
  • Children (less than 2 years) should not spend any time on electronic media (watching television or playing computer or video games).
  • Children (2 to 5 years) should spend less than one hour a day on electronic media.
  • Unless they are sleeping, toddlers and pre-schoolers should always be active and not spend more than one hour at a time without being active.

Children

  • Children (aged 5 to 12 years) should have 60 minutes of a combination of moderate and vigorous physical activity every day:
    • moderate activities include walking, riding a bike or active play
    • vigorous activities include activities of a greater intensity, such as football, netball, running and swimming.
  • A variety of activities are important.
  • Electronic media should be limited.

Adolescents

  • Adolescents (12 to 18 years) should have at least 60 minutes of a combination of moderate and vigorous physical activity every day:
    • moderate activities include walking
    • vigorous activities include running, swimming, training for sport.
  • This amount can be achieved with short sessions of activity throughout the day.

Adults

  • Adults should have at least 30 minutes of physical activity every day.
  • This can be a combination of shorter activities, such as two periods of 15 minute activities, for example one in the morning and one in the afternoon.
  • Adults should think of all body movement as a benefit and be as active as they can every day: an example of this is walking instead of using the car, or taking the stairs instead of the lift.

Older Australians

  • Older Australians should have at least 30 minutes of physical activity on most, if not all, days at a level of moderate intensity.
  • It should be easily manageable and suitable for their capability, despite age, weight, health concerns or abilities.
  • This can be achieved through being active every day in as many ways possible incorporating fitness, strength, balance and flexibility.
  • Older people who are new to starting physical activity or those who have not been active in a while should start at a manageable level and gradually work towards the recommended amount.
  • Older people who regularly participate in a physically active lifestyle are encouraged to carry on in a manner suited to their capabilities, provided they follow recommended safety procedures and guidelines.

People living with chronic conditions

  • Physical activity is necessary to maintain a healthy lifestyle and prevent chronic conditions, but considerations also need to be given to the physical activity requirements for people living with chronic conditions.
  • Living with a chronic disease can impact on a person’s ability to participate in the recommended levels of physical activity. This is an area that needs further development in terms of addressing physical activity.

The national guidelines include recommendations for different age groups but do not acknowledge different cultural groups. It is recognised that for the guidelines to benefit everyone, there need to be different guidelines for different population groups [20][21] including Indigenous people.

Overall, the physical activity recommendations are the same for Indigenous people as for the general population. If the suggested types of physical activity, and the way in which the information is shared [22] were to take cultural issues into account, the information may be more relevant for the Indigenous population. Examples of activities, such as playing golf or doing organised sport, may not be relevant to some Indigenous people, whereas a focus on family activities or more traditional activities may be more relevant.

What is known about physical activity levels among Indigenous people?

The two most recent detailed sources of information on the physical activity levels of Indigenous people are:

Information collected in the 2008 NATSISS for Indigenous children (aged 4-14 years) indicated [Derived from [23]]:

Figure 1 Proportions (%) of Indigenous children aged 4-14 years who participated in physical activity, by state and territory, Australia, 2008

Proportions (%) of Indigenous children aged 4-14 years who participated in physical activity, by state and territory, Australia, 2008

Source: Australian Bureau of Statistics, 2011 [Derived from [23]]

Information collected in the 2008 NATSISS for Indigenous adults (aged 15 years or older) indicated [Derived from [23]]:

Figure 2 Proportions (%) of Indigenous people aged 15 years and over who participated in physical activity, by sex and age group, Australia, 2008

Proportions (%) of Indigenous people aged 15 years and over who participated in physical activity, by sex and age group, Australia, 2008

Source: Derived from Australian Bureau of Statistics, 2011 [Derived from [23]]

Figure 3 Proportions (%) of Indigenous people aged 15 years and over who participated in physical activity, by sex and geographical area, Australia, 2008

Proportions (%) of Indigenous people aged 15 years and over who participated in physical activity, by sex and geographical area, Australia, 2008

Source: Derived from Australian Bureau of Statistics, 2011 [Derived from [23]]

Figure 4 Proportions (%) of Indigenous people aged 15 years and over who participated in physical activity, by sex and state and territory, Australia, 2008

Proportions (%) of Indigenous people aged 15 years and over who participated in physical activity, by sex and state and territory, Australia, 2008

Source: Derived from Australian bureau of statistics, 2011 [Derived from [23]]

Figure 5 Proportions (%) of Indigenous people aged 15 years and over who participated in physical activity, by sex and Indigenous status, Australia, 2008

Proportions (%) of Indigenous people aged 15 years and over who participated in physical activity, by sex and Indigenous status, Australia, 2008

Source: Derived from Australian Bureau of Statistics, 2011 [Derived from [23]]

In the 2004-2005 NATSIHS survey the following levels of physical activity were used:

Survey results for Indigenous people (aged 15 years and over) indicated [24]:

Figure 6 Proportions (%) of Indigenous people aged 15 years and over who participated in some form of physical activity, Australia, 2004-2005

Proportions (%) of Indigenous people aged 15 years and over who participated in some form of physical activity, Australia, 2004-2005

Source: Australian Bureau of Statistics, 2006 [4]

Figure 7 Physical activity levels of Indigenous people aged 15 years and over, by state and territory, 2004-2005

Physical activity levels of Indigenous people aged 15 years and over, by state and territory, 2004-2005

Source: Australian Institute of Health and Welfare, 2011 [24]

What factors contribute to the amount of physical activity that people do?

Some people find it very difficult to take part in physical activity because of certain barriers [14][15][25]. Barriers for Indigenous people can be:

Barriers can also include [14][15][25]:

These barriers can reduce the success of interventions aimed at increasing physical activity among some Indigenous people. These barriers contribute to the low levels of physical activity and high rates of chronic disease among Indigenous people.

Cultural issues need to be respected in the development of policies and strategies, and when creating programs to increase the participation of Indigenous people in physical activity to help reduce the levels of chronic diseases [26]. Physical activity programs developed for the general population may not always be appropriate. Consultation with Indigenous communities when planning and developing interventions is more likely to be relevant and therefore succeed.

What is known about physical activity and chronic disease?

Chronic diseases such as heart disease, diabetes and kidney disease are triggered by many different factors called risk factors. Risk factors [2] can be:

Some chronic diseases may also be caused by, or be a complication of, one or more other diseases. For example having diabetes increases the risk for getting heart disease [27]. Low levels of physical activity are linked with various chronic diseases [2] including:

Cardiovascular disease (CVD)

The main diseases of the cardiovascular system that are most affected by physical activity [7][27][28] are:

Box 3: Cardiovascular disease [27]

Cardiovascular disease (CVD) is the general name given to all diseases of the cardiovascular system (which includes the heart, blood and blood vessels). The main types of CVD in Australia are:

Coronary heart disease (CHD). This occurs when the heart does not receive enough blood. It is usually caused by atherosclerosis (narrowing of the blood vessels due to a build-up of fatty substances in the blood vessels) in the arteries leading to the heart, which eventually results in a complete blockage. The blockage can cause angina (pains, difficulty breathing) and can lead to a heart attack.

Heart failure (cardiomyopathy). This is when the heart is not strong enough to properly pump blood around the body. The heart muscle has become weak, usually as a result of a heart attack, but sometimes due to diabetes, high blood pressure or a damaged heart valve. Weakened heart muscle cannot be repaired.

Stroke. The most common type of stroke is an ischemic stroke. This occurs when a blood clot blocks an artery leading to the brain, or in the brain itself. The result is a lack of blood and oxygen to the brain. Blood clots are most likely to block an artery that has atherosclerosis. Haemorrhagic stroke occurs when a blood vessel in the brain breaks and blood leaks into the brain.

People who are physically active are more likely to have a healthy heart and fewer or no biomedical risk factors (high blood pressure and high levels of blood cholesterol) than people who are not physically active [22]. People with CVD who do some physical activity show improvements in both their physical and social and emotional wellbeing [29]. Australians who are not physically active are twice as likely to die from CHD as those who do regular physical activity [27].

Results from the 2004-2005 NATSIHS [4][28] showed that of all Indigenous people living in non-remote areas who reported having CVD:

Physical inactivity accounts for 30% of the disease burden of CVD in the Indigenous population [30] and 24% of the overall burden of CVD in Australia [27]. The other main contributors to CVD in the Indigenous population [30][31] are:

The benefits of regular physical activity are not only linked to a reduced risk of developing CVD, but in reducing some of the other risk factors for CVD [4][18]:

Positive changes to these factors can lead to overall improvements to cardiovascular health.

Type 2 diabetes

Being physically inactive accounts for 31% of the burden of type 2 diabetes among Indigenous people. Overweight and obesity accounts for 63% of the burden of type 2 diabetes [31]. Physical activity can assist in the prevention and management of type 2 diabetes [14][16][17][18][19] by:

Box 4: Diabetes [32]

There are three main types of diabetes:

  • type 1 (also known as juvenile diabetes or insulin-dependent diabetes)
  • type 2 (also known as non-insulin-dependent diabetes)
  • gestational (also known as diabetes in pregnancy).

Type 2 diabetes is the most common type of diabetes and usually affects people over the age of 45 years (35 years in Indigenous people). It occurs when there is too much sugar in the blood. The body is not able to make enough insulin, or the cells in the body become resistant to insulin. Insulin is necessary to control sugar levels in the bloodstream. If diabetes is not controlled it can lead to heart attack, stroke, kidney failure and eye problems.

Type 2 diabetes can be prevented or managed through weight control, being physically active and eating healthy foods.

Cancer

Being physically inactive accounts for 5% of the burden of cancer among Indigenous people, following tobacco (35%) and alcohol (6%) [31]. Physical activity can help [18][19][29][33]:

How is physical activity involved in the management and treatment of chronic disease?

Physical activity is important not only in the prevention of chronic disease [33], it can also benefit people who already have a chronic disease [29].

Cardiovascular disease

For people with CVD, it is suggested that the greatest benefit from physical activity is among those who were the least active, and benefits can be seen even in low levels of participation [34]. Physical activity was also associated with reduced repeated cardiac events (reduced by around 30%), and reduced hospital readmissions (reduced by around 25%) [35]. For those people with existing CVD, physical activity can lead to improvements in [29][34][35][36][37]:

Type 2 diabetes

Effective treatment and management of type 2 diabetes should include regular physical activity [38] as it can help to:

Overall, this can lead to a reduced risk of CVD which is particularly important for people with diabetes, as their risk of CVD events is twice as high as those who do not have type 2 diabetes [38]. Physical activity also reduces the risk of death from a CVD event for those people with diabetes [39]. The development of long term complications associated with diabetes such as neuropathy (nerve damage), retinopathy (damage to the blood vessels in the eye causing blindness), and nephropathy (kidney disease or damage) can be prevented or delayed by the introduction of regular physical activity. Physical activity can also lead to improved quality of life for those with diabetes, with improvements to social and emotional wellbeing and a reduction in the risk of developing other chronic diseases [38].

Cancer

For people with cancer, physical activity can reduce the risk of death [40] and also lead to improvements in [29]:

What are the other health benefits of physical activity?

Apart from reducing the risk of developing chronic disease, being physically active can also lead to improvements to the musculoskeletal system, changes to areas of the brain that can have an effect on social and emotional wellbeing [22][41], and weight control.

Musculoskeletal system

Particular benefits of physical activity to the musculoskeletal system include [19][22][41]:

Social and emotional wellbeing

Physical activity can improve overall social and emotional wellbeing [19][22][41], and in particular lead to:

Weight control

Overweight and obesity are usually caused by energy imbalances, that is, more energy being taken in to the body (in kilojoules in food) than is being used up (in daily activity) . Physical activity and nutrition both play a key role in maintaining a healthy weight. Healthy eating in combination with physical activity assists in weight control and serves as a protective factor against chronic disease.

Other benefits

Participating in regular physical activity also helps to [18][19]:

Summary

Regular physical activity can assist in the prevention and management of chronic disease and other health problems.

There are many barriers that prevent Indigenous people from taking part in regular physical activity: historical; cultural; geographical; and socio-economic factors all contribute. As a result, physical inactivity is the third leading cause of disease burden for Indigenous people.

Low levels of physical activity are linked with various chronic diseases. Chronic disease accounts for almost three-quarters of the observed difference in the burden of disease between the Indigenous and non-Indigenous populations. The main chronic diseases that are linked with physical inactivity are cardiovascular disease, type 2 diabetes and some cancers.

Being physically active can have other health benefits including to the musculoskeletal system, and can help with social and emotional wellbeing and weight control.

Endnotes

  1. Modifiable risk factors can be changed such as diet and blood pressure. Non-modifiable risk factors cannot be changed such as age or gender.
  2. The term Indigenous is used in this review to refer generally to the two Indigenous populations of Australia –Aboriginal people and Torres Strait Islander people.
  3. In this review the following acronyms are used for the states and territories: New South Wales (NSW); Victoria (Vic); Queensland (Qld); Western Australia (WA); South Australia (SA); Tasmania (Tas); Australian Capital Territory (ACT); and Northern Territory (NT).
  4. Of all Indigenous people 15 years and older that took part in the survey, around 90% identified their status as Aboriginal, around 5% identified as Torres Strait Islander, and around 5% identified as both Aboriginal and Torres Strait Islander.

References

  1. Physical activity (2012) World Health Organization
  2. Australian Institute of Health and Welfare (2008) Indicators for chronic diseases and their determinants: 2008. Canberra: Australian Institute of Health and Welfare
  3. Australian Bureau of Statistics (2009) National Aboriginal and Torres Strait Islander social survey, 2008. Retrieved 11 April 2011 from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4714.0?OpenDocument
  4. Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. Canberra: Australian Bureau of Statistics
  5. Australian Bureau of Statistics, Australian Institute of Health and Welfare (2008) The health and welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008. Canberra: Australian Bureau of Statistics and Australian Institute of Health and Welfare
  6. Australian Institute of Health and Welfare (2010) Premature mortality from chronic disease. Canberra: Australian Institute of Health and Welfare
  7. Australian Institute of Health and Welfare (2010) Australia's health 2010: the twelfth biennial report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare
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  11. Wilkinson R, Marmot M (2003) Social determinants of health: the solid facts. Denmark: World Health Organization
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© Australian Indigenous HealthInfoNet 2013 
This product, excluding the Australian Indigenous HealthInfoNet logo, artwork, and any material owned by a third party or protected by a trademark, has been released under a Creative Commons BY-NC-ND 3.0 (CC BY-NC-ND 3.0) licence. Excluded material owned by third parties may include, for example, design and layout, images obtained under licence from third parties and signatures.

 

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