As noted in Chapter 4, life expectancy is lower in Aboriginal and Torres Strait Islander communities and the burden of disease from chronic conditions is greater than in the wider community (Australian Bureau of Statistics 2001). For example, Type 2 diabetes and coronary heart disease are the major causes of death and are more prevalent at a younger age in Aboriginal and Torres Strait Islander adults (Australian Bureau of Statistics 2003). A review in the Getting Australia Active update (Bull, Bauman et al. 2004) found few published studies focusing on this community and none specifically focusing on older people. As in other population sectors, physical inactivity and obesity are key risk factors for a range of comorbidities. Mental health problems need particular attention: they not only influence quality of life, but act as risk factors for coronary heart disease. There is thus great scope to focus on physical activity promotion in this community, to address complex health problems. Physical activity has the potential to promote both individual and community health by contributing to capacity building and reducing social isolation.
The Royal Australian College of General Practitioners report ‘Evidence base to a preventive health assessment in Aboriginal and Torres Strait Islander peoples’ contains a series of recommendations regarding physical activity behaviour (National Aboriginal Community Controlled Health Organisation 2005). No specific focus upon older Indigenous people was provided. The recommendations largely reflected the mainstream literature: very little research has been conducted on interventions specific to the Indigenous Australian population. The evidence has largely been derived from studies of Causcasian older people, which poses limitations upon its generalisability.
CLDB groupsA review conducted in the late 1990’s specifically focused on identifying physical activity interventions for those of CLDB located only ten studies and thus stated that it was premature to discuss the public health implications of the research (Taylor, Baranowski et al. 1998). Hillsdon et al’s more recent systematic review did not include any studies that specifically examined the effectiveness of physical activity interventions in older people from different minority groups (Hillsdon, Foster et al. 2005).
Authors have recommended systematic use of theoretically based approaches when promoting physical activity in CLDB communities (Taylor, Baranowski et al. 1998; Conn, Minor et al. 2003). Targeting physical activity promotion has been shown to be particularly effective with CLDB women. There has been less research involving CLDB males. Qualitative data from NSW’s long-standing AIM program - a series of classes at a variety of community venues- confirms the importance of social and structural factors in supporting physical activity in CLDB and frail older people (Stickney and Vilshanskaya 2005). Socialisation often triggered attendance in the former group. People maintained attendance due to the health benefits gained. The frail older people were more likely to begin exercising to aid health programs whilst they continued to attend because of the social benefits. Participants valued the respect afforded them by the facilitators. Providers aimed to enable service flexibility, linking with community partners to address access issues such as cost and transport. The heterogeneity of the CLDB groups was recognised: both mixed and language-specific groups operated.
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US researchers have explored strategies for attracting different CLDB groups to physical activity programs. King et al. compared a random-digit dial telephone campaign to a community media campaign and found no ethnic differences in response to these two modes (King, Harris et al. 1994). Another US study involving African American, Latina and Asian women found a preference amongst all three groups for passive approaches, i.e. where the person sees a message and responds to it, rather than an active approach, i.e. where the researcher (or provider) contacts the person directly (Lee, McGinnis et al. 1998) . Wilbur and colleagues (2001) reported a higher recruitment efficiency in Caucasian compared to African American middle-aged women (45-65 years old). Recruitment by email was more successful than flyers, newsprint and television coverage for both groups. Their results are limited in their generalisability as the women were all employed and chiefly professionals.
There is a scarcity of culturally specific tools for determining outcomes from potentially useful program models. As Taylor and colleagues state, any new study with CLDB groups should ensure that the outcome measures are reliable and valid for use in that group (Taylor, Baranowski et al. 1998).
The existing research does not allow discernment of whether programs need to be tailored to each specific CLDB group separately, or whether more generic principles and processes can be used across a number of CLDB groups. Whilst not specific to older people, a number of recommendations have been proposed when mounting health promotion programs for CLDB groups (Figure 9.2).
Figure 9.2 Recommendations for conducting culturally appropriate physical activity programs
Source: Pasick 1996
SummaryPhysical activity can assist in the management of a range of health problems, level of frailty and setting, offering a low cost, non-pharmacological option as an independent therapy or adjuvant to traditional drug therapies. More evidence is needed about the sustained effects of programs. A comprehensive economic analysis is needed of interventions in order to make a proper cost benefit analysis to guide future planning. There is ample level II evidence for strength and flexibility training for frail older people in their own homes and in residential aged care accommodation and developing evidence for balance/mobility and cardiovascular training programs in this group. However, we need more information about which frail older people may be best to target. There is very limited evidence to enable generalisation of trial findings to the various cultural groups living in Australia. Evidence concerning Indigenous Australians and the impact of physical activities is particularly scarce.
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