Understanding the Factors that Impact on Participation in Physical Activity by Rural Aboriginal Adults

Transcription

1 Understanding the Factors that Impact on Participation in Physical Activity by Rural Aboriginal Adults Shanthi Ramanathan Executive Officer, The Gilmore Centre 5th National Rural Health Conference Adelaide, South Australia, 14-17th March 1999 Proceedings

2 Understanding the Factors that Impact on Participation in Physical Activity by Rural Aboriginal Adults Shanthi Ramanathan THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND HEALTH Research has shown that even a moderate level of regular physical activity has many physical and mental health benefits. According to recent estimates, as much as one-third of deaths caused by cardiovascular disease, coronary heart disease, diabetes mellitus and colon cancer can be linked to sedentary living. 1,2,3 Another benefit of regular exercise includes contributing to the maintenance of a healthy weight and is closely associated with national efforts to reduce obesity in Australia. 4 According to recent estimates, physical inactivity may also be responsible for at least a three-fold increase in the risk of stroke 5,6 and an increase in the incidence of hypertension 7. Even moderate physical activity such as walking for at least 30 minutes daily has been shown to have significant health benefits and leading agencies like the World Health Organisation, United States Centres for Disease Control and Prevention and the UK Department of Health concur on the amount and type of activity that is necessary for significant health benefits. 8,9,10,11 CURRENT AUSTRALIAN INITIATIVES In line with this global movement towards encouraging physical activity, two initiatives that directly impact on the decision to undertake this research are the launch of the Active Australia Campaign (a national participation framework aimed at getting all Australians involved in physical activity) and the establishment of the NSW Physical Activity Taskforce to promote physical activity in NSW from There was also a special communication by the Chief Health Officer of NSW in October 1995 stating that Every adult in New South Wales should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week. 12 THE PHYSICAL ACTIVITY SCORECARD Unfortunately, research has also shown that, currently, less than half the adult population in NSW meet the minimal requirement of 30 minutes cumulative physical activity per day. 13 Participation also decreases with age and is lower among persons from lower socio-economic groups. 14, 15 Aboriginal and Torres

3 Strait Islander people have also been identified as a target group who have lower rates of adequate physical activity than the general population. 16 This has influenced the selection of adult Aboriginals as the target group for this project. THE ABORIGINAL POPULATION, THE JUSTIFIABLE TARGET GROUP Early accounts of white settlers confirm that the indigenous population in the 1700s was much healthier than their white counterparts 17. Their lifestyles including the food they ate, their level of physical activity, and their social structures were appropriate for their environment and situation. With time, their health deteriorated as they were displaced from their lands, dispossessed of their culture and traditions and exposed to a variety of infectious diseases to which they had no immunity. In addition it was also the process by which a predominantly nomadic and dispersed people were forced towards a more centralised and sedentary way of life that has had and continues to have a major impact on the health status of Aboriginals in Australia today. The adoption of houses, automobiles and communities was a social change of enormous importance to the lifestyle of Aboriginals and the type, frequency and intensity of physical activity they engaged in 18. Physical activity that used to be a part of daily living (incidental activity) diminished rapidly and with it the simultaneous emergence of lifestyle diseases such as CHD, diabetes mellitus and stroke that were unheard of in traditional Aboriginal societies. Today, the Aboriginal population has a higher incidence than the general population of some diseases associated with low levels of physical activity such as diabetes mellitus and circulatory diseases such as coronary heart disease and hypertension. 19 Between , Aboriginal death rates from diabetes were 12 times greater for men and 17 times greater for women than rates for other Australians. 20 The incidence of obesity amongst adult Aboriginals has also been on the increase. While there seems to be fairly good documentation of these Aboriginal health problems, little research has centred on the development of interventions to overcome them. Despite the overwhelming evidence that physical activity is a key component of a healthy lifestyle, few studies have focused specifically on identifying factors that influence participation by Aboriginals. In her report to the Department of Arts, Sport, the Environment, Tourism and Territories on Recreation in the Aboriginal Community, Atkinson concentrated on sport as being only one aspect of recreation. An interesting finding of her study that further highlights the need for more research in the area was the declining participation in team sports (football, basketball, netball, touch) as the community aged. Rates decreased from 27% (10-20yrs) to 7% (21-35yrs) to 0% (36yrs and over) for females and from 74% (10-20yrs) to 35% (21-35yrs) to 4% (36 and over) for males. Despite sport being only a component of the study, many of the 40 recommendations that resulted focused mainly on the need for

4 Aboriginal involvement in all aspects of the development and management of their own sport and recreation and the need for ongoing government support in the area 21 The Tasmanian Aboriginal sport & recreation activity survey undertaken by Vickery and Hagan assessed participation levels, appraised barriers to involvement and evaluated activity preferences for the target group. The study was quantitative in nature using structured questionnaires and almost 43 per cent of the respondents were under 20 years of age. 22 While the study provides useful baseline data, it does not provide any in-depth information about the impediments to physical activity or the factors that encourage participation on a regular basis by this group. AN APPROPRIATE METHODOLOGY In order to achieve the desired outcome, a qualitative methodology was employed. A naturalistic, qualitative methodology using an inductive strategy was ideal in this situation because of the absence of a well-developed body of knowledge about Aboriginals and physical activity. It allowed the physical activity needs of Aboriginals, as perceived by members of their group, to be identified and articulated and to shape and influence the development of strategies and programs to encourage physical activity in their respective communities. Wagga Wagga, a rural city of approximately 60,000 people and Brungle, a small, isolated Aboriginal settlement of approximately 40 people, were selected as the project sites. Brungle and Wagga vary significantly in the provision of opportunities for physical activity and all other forms of community infrastructure and resources. The social, cultural, environmental and economic factors that impact on both these communities also differ. It was hoped that this would allow a meaningful comparison of the data obtained from both sites. Specifically, the research method of ethnography was used in order to discover and understand the underlying patterns and rules of behaviour in relation to participation in physical activity by adult Aboriginals. The study began by gaining access to the particular culture/community and establishing rapport with its members. This was done via a selected local person who introduced me to the group and assisted me in gaining entry and acceptance by the group. The research project and my intentions for being there were made known at the outset. Rapport was gradually built with the group by visiting them on several occasions (Brungle) and participating in some of their activities (Wagga). Equipped with a functional understanding of the cultural context of each community, decisions were made about the data collection phase such as details about, who would be approached for interview, when and where the interviews would take place and how they would be structured. All interviewees have volunteered as informants and their informed consent was an essential requirement for participation. Ethics committee approval was sought and

5 received from the Charles Sturt University Ethics Committee and written support for the project was received from the Aboriginal Land Councils in Wagga Wagga and Tumut (which has jurisdiction over Brungle). Data collection (Wagga Wagga only) To date, ten interviews have been carried out in Wagga Wagga. Participants ranged from 18 to 66 years with 60 per cent being female and 40 per cent male. All interviews were semi-structured using an interview schedule as a guide. The information sought pertained to: how they viewed physical activity; the relationship between physical activity and health,; whether they perceived physical activity as a good or bad thing; their favourite forms of activity; their level of involvement in physical activity; their reasons for involvement or non-involvement; their level of activity when they were younger; and whether they would like to undertake more activity and what would motivate them into action. Preliminary analysis Participants defined physical activity in much the same terms as you would expect from mainstream Western society. Definitions clustered around three major concepts: activity and movement with terms like exercising, sport, walking, sprinting gardening, manual labour and football ; physiology and body image with terms like increasing the heart rate, muscle tone and having a good body image ; and enjoyment with terms like fun gives one a good feeling, it s a family fun thing playing with the kids. Only one participant defined physical activity as something you did as a family, not as an individual which is in line with the literature that documents organised physical activity in traditional Aboriginal communities as being a communal undertaking with the whole community participating. When asked about the relationship between physical activity and health, all participants saw this as a direct and positive relationship. They saw physical activity as contributing to many aspects of health including: Physical health Physical activity ensures you are fit and healthy and helps you stay alive ; Exercise helps to maintain weight especially now that we eat a lot of the wrong foods ; Without exercise, health deteriorates ;

6 "Fitness is a health issue. It prevents against diabetes and heart disease and improves breathing ; Exercise increases your metabolic rate which is good for health. It increases stamina and fitness especially if you do it everyday. Mental /Emotional health Physical activity increases the quality of life the interaction and camaraderie experienced during sport and exercise is healthy ; The more activity I do the more energy I have so the better I feel inside ; Exercise increases self-esteem and helps to control weight which helps you feel good about yourself ; The more I walk, the better I feel. Perception about physical activity amongst participants was predominantly positive. Once again many stressed its importance in promoting and maintaining good health, increasing energy levels, increasing self-esteem and selfconfidence, managing stress, allowing one to take aggression out in a nonthreatening and damaging manner, having fun and enjoying oneself, promoting physical fitness, getting to meet different people and socialise, weight control, prevention of aches and pains, the management of ailments such as asthma. When asked about their favourite activities, there was a mixture of responses with a fairly even mix of individual and group activities including: walking, swimming, cycling, running, a gym workout, weight lifting, jogging, manual labour, golf, lawn bowls, bowling; group activities: softball, rugby league, touch football, netball, soccer, basketball and footie. The activities mentioned are considered fairly mainstream and did not reflect any traditional activities undertaken by Aboriginal communities as mentioned in the 1991 report Recreation in the Aboriginal Community by Atkinson. This highlights the erosion of more traditional activities and sport as Aboriginal communities have adopted a more 'Western' lifestyle. When asked if they engaged in any of the mentioned activities regularly, there was a mixed response. Several did not engage in any form of activity on a regular basis, some did a bit of walking and incidental activity like gardening once a week but only a few played either a game or walked regularly. In general it is safe to say that all participants have seen a major decline in their physical activity levels as they have grown up, left school and reached adulthood. The younger ones also seemed to be more active although age was not necessarily an indicator for level of activity as the eldest participant was a regular walker. The most important portion of the interview concentrated on the factors that impacted on participants engagement in physical activity. The factors that promoted activity and those that were barriers to activity are categorised into two tables below:

7 MOTIVATORS FOR PHYSICAL ACTIVITY Factors Responses Social I enjoy the company that I exercise with, particularly my family, friends and colleagues. Friends make exercising enjoyable. I really like exercising with someone I know. It is a great way to meet people. Personal I do it just for the personal enjoyment and fun I get out of it. I know I need to build up strength and that motivates me. I get a personal enjoyment from exercising on my own and it helps me control my weight. I do not see age as a barrier to activity. In fact it motivates me. Economic Activities such as walking don t cost me anything. Environmental Wagga is a good place. It has many choices of activities. It is also safe and has good lighting which allows me to walk even in winter when it gets dark early. Safety has never been a problem in Wagga and I find walking more accessible here than in Sydney. Wagga is a good place for sport. There are lots of gyms and I feel comfortable in a gym. Wagga is an excellent place for physical activity. Sporting venues are close and accessible. There is no problem with comfort. Summer is a lot more conducive to exercise. Of the factors that promote physical activity amongst this group, the environmental factors such as safety and accessibility of locations for activity seemed to feature strongly with Wagga Wagga given an excellent evaluation. The issue of weather was also raised. Personal and social factors also played a major part in encouraging activity with many undertaking activity because they enjoyed the company and social aspect of sport or for the personal enjoyment they experienced. Weight control and age were also seen as motivating factors.

8 BARRIERS TO PHYSICAL ACTIVITY Social Sport was more directed at boys. It was not seen as a girl thing in my family. Since I have been back from Sydney after 15 years away, I haven t made a lot of friends that want to walk. I feel insecure about exercising in public. Gyms are full of men and I don t feel comfortable. In gyms, people are so unfriendly. You are pressured into looking a certain way and people there seem like show ponies in tight leotards. There is also such an emphasis on body fat. I don t see a social benefit in exercising. I have much more fun being a spectator and supporting my kids. Personal My children have always taken first priority. Now that I have the opportunity, I do not seem to have the urge to do any activity. I have become lazy and I am not motivated. The lack of time is my major barrier. I am working and studying part-time and I just cannot fit in regular exercise. I can only do what my body tells me is right which is much more limited than in my younger days. I used to exercise regularly in my lunch hour but the extra workload has made this impossible. I do a lot of travelling which makes it hard to have a routine. I used to walk to work but now I have no time so I end up driving. It is a real challenge to exercise regularly. Economic The cost of many activities turn me off. I would like to try rowing but it cost too much money. Even track suits and shoes can cost a fortune. I would like to join a gym and do circuit training but it just costs too much. I enjoy cycling and would like to get a good bike and helmet but there are too many competing factors for the same resources. The children s sport take up most of our recreation money. Its amazing how much fees and sporting gear can cost. Environmental Sometimes it is just too cold outdoors to bother. The weather in Wagga is not very conducive to outdoor activity. In winter it gets too dark and cold and in summer its too hot.

9 The most significant barriers to activity for the participants seem to be the lack of time and motivation, the lack of self-confidence, the feeling of unease about exercising in public and the cost factor. These factors will need to be taken into consideration when selecting strategies to encourage physical activity amongst this group. CONCLUSION One of the major limitations of this project at present is that the participants interviewed in Wagga Wagga have been from the higher end of the socioeconomic spectrum of Aboriginals. Most of them were well educated, articulate, employed or retired and placed as leaders in their communities. Their experiences do not necessarily reflect those of the entire Aboriginal population in Wagga Wagga. Efforts are now underway to supplement these findings with those from other Aboriginals in Wagga as well as the participants in Brungle. The additional findings should give a more holistic picture of the physical activity situation and lifestyle of Aboriginals residing in the two selected rural communities. By and large, the study seems to reflect that the Aboriginal community is convinced of the health benefits of regular physical activity, have a similar concept of physical activity to the rest of Australian society and face the same impediments to undertaking regular activity. Thus, the solution lies not in more education about the benefits of daily exercise but in provision of more appropriate opportunities for regular activity including tying it into family and work obligations. REFERENCES Blair SN, Kohl HW, Paffenbarger RS, Clark DG, Cooper KH, Gibbons LW. Physical fitness and all cause mortality: a prospective study of healthy men and women. Journal of the American Medical Association 1989; 262: Haskell WL. Health consequences of physical activity: understanding and challenges regarding dose response. Medicine and Science in Sports and Exercise 1994; 26(6): Powell KE, Blair SN. The public health burdens of sedentary living habits: theoretical but realistic estimates. Medicine and Science in Sports and Exercise 1994; 26(7): National Health and Medical Research Council. Acting on Australia s weight: a strategic plan for the prevention of overweight and obesity. Canberra : AGPS, Wannamethee G, Shaper AG. Physical activity and stroke in middle aged men. British Medical Journal 1992; 204: Fletcher GF. Exercise in the prevention of stroke. Health Reports 1994; 6(1): Fagard RH. Physical fitness and blood pressure. Journal of Hypertension 1993; 11(5): Bijnen FCH, Caspersen CJ & Mosterd WL. Physical inactivity as a risk factor for coronary heart disease: a WHO and International Society and Federation of Cardiology position statement; Bulletin of the World Health Organisation 1994; 72(1):1-4. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C et al Physical activity and public health. A recommendation from the Centres for Disease Control and Prevention and the American College of Sports Medicine. Journal of the American Medical Association 1995; 273:

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