Research article
Physical Activity Levels in American-Indian Adults: The Strong Heart Family Study

https://doi.org/10.1016/j.amepre.2009.07.019Get rights and content

Background

A limited body of evidence, mostly based on self-report, is available regarding physical activity levels among American-Indian adults.

Purpose

This study aims to examine physical activity levels objectively using pedometers among a large cohort of American-Indian adult participants in the Strong Heart Family Study (SHFS).

Methods

Physical activity levels in 2604 American-Indian adults, aged 18–91 years, from 13 American-Indian communities were assessed using Accusplit AE120 pedometers over a period of 7 days during 2001–2003. Anthropometric measurements were also assessed. All data analyses were conducted in 2008. Age-adjusted Pearson correlations were used to examine the relationship between average steps per day and age and anthropometric variables. Subjects were placed in age and BMI categories (according to National Heart, Lung, and Blood Institute cut points) to examine trends in physical activity with increasing age and BMI.

Results

Daily pedometer steps ranged from 1001 to 38,755. Mean step counts by age group for men were 5384 (aged 18–29 years); 5120 (aged 30–39 years); 5040 (aged 40–49 years); 4561(aged 50–59 years); 4321 (aged 60–69 years); and 3768 (aged ≥70 years) and for women, 5038 (aged 18–29 years); 5112 (aged 30–39 years); 5054 (aged 40–49 years); 4582 (aged 50–59 years); 3653 (aged 60–69 years); and 3770 (aged ≥70 years). A significant linear trend in physical activity was noted with increasing age (p=0.002 for men, p<0.0001 for women) and with increasing BMI (p=0.05 for men, p=0.04 for women).

Conclusions

Objectively measured data suggest that inactivity is a problem among American-Indian adults and that a majority of American-Indian adults in the SHFS may not be meeting the minimum physical activity public health recommendations. Efforts to increase physical activity levels in this population are warranted.

Introduction

It has been suggested that physical activity provides numerous health benefits, including the prevention of many chronic diseases.1, 2, 3 Research has demonstrated that habitual physical activity is associated with reduced morbidity and mortality from various chronic diseases and conditions such as cardiovascular disease,4, 5, 6 diabetes,7, 8, 9 hypertension,10, 11, 12 obesity,13 and cancer.14, 15 Despite this well-documented evidence, many individuals continue to lead relatively sedentary lives.16

Physical inactivity appears to be a problem in all facets of the U.S. population, especially among minority populations. A limited body of evidence is available regarding physical activity levels among American-Indian adults. The available data do, however, suggest that American-Indian adults participate in relatively low levels of physical activity,17, 18, 19, 20, 21, 22, 23, 24 in many instances lower than their minority counterparts.21 According to Schoenborn et al,17 at least five in ten American-Indian adults are physically inactive, with women more likely to be inactive than men (55.5% vs 42.5%). This same report suggests that roughly 26.4% of this population do not meet the Surgeon General's recommendations for physical activity participation.

Unfortunately, most of this evidence is based on physical activity data collected using subjective methods. Self-report measures of physical activity often suffer from reporting bias and may over- or under-estimate physical activity levels because of the fact that questionnaires often capture only moderate-to-vigorous physical activity and activities that are structured or planned.25 For an accurate assessment of activity to be achieved, the assessment tool used must elicit information on the types of physical activities that encompass the greatest proportion of energy expenditure in the study population. In investigations in which it can be assumed that low-intensity activities, as well as unstructured activities, are similar across populations, a self-report measure may be appropriate. However, in certain subgroups, such as older adults, injured/impaired individuals, or individuals for whom lower-intensity activities may constitute the bulk of their physical activity, the use of a subjective measure to assess physical activity is likely to miss a substantial portion of activities that make up their total energy expenditure. In this case, an objective measure of physical activity should be considered to better assess total activity, including low-intensity and unstructured physical activity.25

The purpose of the current study was to examine physical activity levels in a large cohort of American-Indian adults from three geographic locations across the U.S. and to examine trends within this population. Physical activity was assessed with a pedometer, which will allow for objective comparisons across these populations.

Section snippets

Strong Heart Family Study

The Strong Heart Family Study (SHFS) is a longitudinal study of cardiovascular disease, its risk factors, and genetic determinants in 13 American-Indian communities from three geographic regions in Arizona, Oklahoma, and North Dakota and South Dakota. The SHFS includes two clinical examinations and ongoing mortality and morbidity surveillance. In 2003, the SHFS recruitment and examination of family members was successfully met and included a total of 96 extended families (Arizona, 33; Oklahoma,

Results

A total of 3665 participants were enrolled in the SHFS. Of these participants, 2604 men and women (71% of the Phase IV Cohort) aged 18–91 years met the inclusion criteria and were included in the analyses. Table 1 presents the descriptive characteristics of the entire sample stratified by gender (male/female) and by age group (18–29, 30–39, 40–49, 50–59, 60–69, and ≥70 years).

Participants' daily pedometer steps ranged from 1001 to 38,755, with a mean number of steps per day for the entire

Discussion

In this first study to examine physical activity using an objective measure, it was found that regardless of gender or age-group classification, participants in the SHFS have mean pedometer values well below aggregated reference points.37 In fact, pedometer steps among male participants ranged from an average low of 3111 among those aged >70 years to a high of 5078 among those aged 18–29 years (Figure 1), and among female participants in the SHFS, pedometer steps ranged from a mean of 3170

References (44)

  • P.D. Thompson et al.

    Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease

    Circulation

    (2003)
  • W.C. Knowler et al.

    Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin

    N Engl J Med

    (2002)
  • K.F. Erikkson et al.

    Prevention of type 2 (non-insulin dependent) diabetes mellitus by diet and physical exerciseThe 6-year Malmö feasibility study

    Diabetologia

    (1991)
  • X.R. Pan et al.

    Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the Da Qing IGT and Diabetes Study

    Diabetes Care

    (1997)
  • J.M. Hagberg

    Exercise, fitness, and hypertension

  • J.M. Hagberg et al.

    Does exercise training play a role in the treatment of essential hypertension?

    J Cardiovasc Risk

    (1995)
  • G. Hu et al.

    Relationship of physical activity and body mass index to the risk of hypertension: a prospective study in Finland

    Hypertension

    (2004)
  • R.R. Wing et al.

    Successful weight loss maintenance

    Annu Rev Nutr

    (2001)
  • R.A. Breslow et al.

    Long-term recreational physical activity and breast cancer in the National Health and Nutrition Examination Survey I epidemiologic follow-up study

    Cancer Epidemiol Biomarkers Prev

    (2001)
  • M.L. Slattery et al.

    Physical activity and colon cancer: confounding or interaction?

    Med Sci Sports Exerc

    (2002)
  • Leisure-time physical activity among adults: U.S., 1997–98

    (2002)
  • C.A. Schoenborn et al.

    Health behaviors of adults: U.S., 1999–2001

    Vital Health Stat 10

    (2004)
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