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Try out PMC Labs and tell us what you think. Learn More. A limited body of evidence, mostly based on self-report, is available regarding physical activity levels among American-Indian adults. This study aims to examine physical activity levels objectively by pedometer among a large Days indian adult personal on i 40 of American Indian adult participants in the Strong Heart Family Study.
Physical activity levels in American-Indian adults, aged 18—91 years, from 13 American-Indian communities were assessed using an Accusplit AE pedometer over a period of 7 days during — Anthropometric measurements were also assessed. All data analyses were conducted in Age-adjusted Pearson correlations were used to examine the relationship between average steps per day and age and anthropometric variables.
Daily pedometer steps ranged from to 38, 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. It has been suggested that physical activity provides numerous health benefits including the prevention of many chronic diseases. Physical inactivity appears to be a problem in all facets of the U. 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 — 24in many instances, lower than their minority counterparts.
This same report suggests that roughly Unfortunately, most of this evidence is based on physical activity data collected using subjective methods. In investigations where it can be assumed that low-intensity activities, as well as unstructured activities, are similar across populations, a self report measure may be appropriate. In this case, an objective measure of physical activity should be considered to better assess total activity including low-intensity and unstructured physical activity.
The purpose of the current study was to examine physical activity levels in a large cohort of American Indian adult from three geographic locations across the U. Physical activity was assessed with a pedometer, which will allow for objective comparisons across these populations. The SHFS includes two clinical examinations and ongoing mortality and morbidity surveillance.
Inthe SHFS recruitment and examination of family members was successfully met and included a total of 96 extended families 33—AZ, 36—OK, and 27—DA totaling 3, participants from all three centers ranging in age from 14 to 93 years. As part of the SHFS, participants completed both a personal interview and physical examination. The personal interview solicited information about demographics, health habits, and medical history.
The physical examination included measures such as physical activity and anthropometric measurements. All participants gave informed consent for the present study, which was approved by the IRBs at all of the participating institutions. Physical activity was assessed using an Accusplit AE pedometer Accusplit Inc, San Jose, CA which has been shown to be a valid and reliable assessment tool for assessing step counts in a variety of laboratory and field settings.
There has been some suggestion that spring-lever pedometer accuracy may be compromised in individuals with large BMIs or excess frontal body mass where the pedometer may not remain upright in the vertical plane. This procedure was used only in rare cases when the pedometer failed to meet acceptable standards after a step accuracy test. At the end of the 7-day period, participants were asked to return their pedometer diary to the clinic in a postage paid envelope.
The mean of steps the participant takes per day was calculated by averaging the of steps recorded each day during the 7-day period. Since research has suggested that 3 days of activity can provide a sufficient estimate of weekly physical activity 36 ; participants with 3 or more days of data were included in the study. Steps per day averaged over the week was calculated for any person who had data for 3 or more days, taking the sum of steps per day divided by the of available days.
Body composition measures were determined using anthropometry. Height was recorded using a vertical mounted ruler and measures were recorded to the nearest centimeter. Waist measurements were obtained using an anthropometric tape applied at the level of the umbilicus with the patient supine and breathing quietly and recorded to the nearest centimeter. Descriptive statistics were calculated for the cohort in total and separately by gender and age group.
All continuous data were assessed for normality. Normally distributed data are reported as mean SDnon-normal variables as median 25 thDays indian adult personal on i 40 th percentile. Pedometer data were found to be skewed and natural log transformed prior to analyses. Jonckheere-Terpstra tests were used to estimate the linear trend in physical activity levels across age groups stratified by gender.
Pearson partial correlation coefficients adjusted for age were used to evaluate the association of physical activity determined by pedometer steps and anthropometric measures such as BMI, waist and hip circumference, and waist-to-hip ratio for the cohort stratified by gender. Statistical analyses were performed using Statistical Analysis Software, version 8.
Healthy participants were considered to be any that did not report a severe chronic disease or disability that may limit their physical activity level. Therefore, participants were eliminated from the analyses if they reported having any of the following conditions that may limit their physical activity: rheumatic heart disease, renal dialysis, kidney failure, cirrhosis of the liver, emphysema, above or below knee amputation, or unable to walk. Eliminating values this low is not uncommon since they may be considered beyond that expected in people that are physically inactive and may likely reflect not wearing the monitor.
A total of participants were enrolled in the Strong Heart Family Study. Figure 1 presents mean pedometer step counts of the SHFS cohort stratified by age group and gender. Additionally, regardless of gender, younger adults, on average, have higher mean pedometer step counts than older adults. There was no ificant difference between reported physical activity levels based on pedometer steps between men and women adjusted for age Similar to the findings within age groups, regardless of gender, those participants with lower BMIs have higher mean step counts compared to those with larger BMIs.
In this first study to examine physical activity using 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. These low step counts would suggest that a large proportion of the sample is not meeting the current CDC and American College of Sports Medicine recommendations for physical activity.
Other studies conducted among racially or ethnically diverse free-living samples with pedometer assessed physical activity have found that minority individuals tend to be less active than the suggested national recommendations. Bennett et al. In this study, mean SD pedometer step counts ranged from This is in contrast to the findings of the SHFS study in which mean pedometer steps ranged from Additionally, the Cross-Cultural Activity Participation Study 38 found median daily step counts ofandamong American Indian and African American women mean age In comparison, female participants in the SHFS aged 50—60 years were found to have slightly lower median steps counts of These findings confirm that the current sample of American Indian adults is at least as inactive as other minority samples.
When examining physical activity levels by gender in the SHFS, unlike in studies, 1643 — 45 no ificant Days indian adult personal on i 40 were found between men and women in age-adjusted, pedometer-determined physical activity levels. This finding is likely due to the lack of variability in physical activity levels across the entire SHFS population and the very low levels of activity among both men and women in the SHFS.
In contrast, when the relationship between age and physical activity was examined categorically, it was found that physical activity declined with increasing age, which is often shown in population studies. These findings are consistent with other studies that have shown decreasing levels of physical activity with increasing BMI. The Strong Heart Family Study provided the unique opportunity to examine physical activity levels in a large cohort of American Indian individuals using an objective measure, more specifically the pedometer.
To date, most studies that have examined physical activity levels in American Indian populations have utilized subjective measures such as a questionnaire to assess physical activity in their population of interest. While this method of assessment is relatively reasonable in large population studies, it relies on participant recall and may not provide an adequate assessment of lower intensity, unstructured physical activities like walking and housework.
By utilizing a pedometer, it was possible to eliminate some of the problems posed by the use of subjective measures and possibly obtain a truer representation of physical activity levels among American Indian adults. However, despite the advantages of using the pedometer to capture unstructured and low-intensity physical activity in the SHFS, there are, unfortunately, limitations that need to be considered with its use as an assessment tool. First, the pedometer does not measure activities that are not ambulatory in nature such as resistance training and cycling.
Additionally, many pedometers, such as the pedometer used in the current study, lack an internal clock and data storage capability; thus it was necessary to rely on the SHFS participants to accurately record their step counts from the pedometer in their 7-day activity diary. This process may have resulted in reporting errors or lack of data. Further, the pedometer used in this study is unable to discriminate between steps accumulated in walking, running, or stair climbing; therefore, it was not possible to determine intensity of activity. Finally, participant clothing or body habitus may have played a role in the accuracy of the pedometer.
In order for a pedometer to accurately assess physical activity, it must be worn snug to the body and kept upright in a vertical plane, perpendicular to the ground. Although every effort was made to ensure that participants were properly instructed on how to wear the pedometer, there was no guarantee that this occurred. Therefore, if the pedometer was not worn in a correct manner, the pedometer may not have worked properly and may have resulted in an underestimation of physical activity levels for those specific individuals. Other limitations that should be considered when interpreting these findings include the fact that the SHFS is made up of 96 large families selected across three geographic locations and not a random sample of American Indian communities.
It has been suggested that physical activity levels may be similar in related individuals or those who share a related environment, therefore reducing inter-individual variation of physical activity levels. Individuals were treated as if they were completely independent of each other, and family structure and environmental influences were not taken into when evaluating physical activity levels.
The estimates of physical activity are believed to be reflective of their low levels of physical activity. However, the variability may be underestimated in this population. In summary, this study is the first to objectively determine physical activity levels in a large sample of American Indian adults.
The findings of this study suggest that based on pedometer steps, a majority of American-Indian participants in the Strong Heart Family Study are not meeting the minimum physical activity public health recommendations. Since physical activity has been shown to reduce the risk of developing many chronic diseases, efforts to increase physical activity levels in this population are warranted. The authors acknowledge the assistance and cooperation of the participating tribes and the Indian Health Service facilities that serve those tribes.
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Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The opinions expressed in this paper are those of the author s and do not necessarily reflect the views of the Indian Health Services. No other authors reported financial disclosures. National Center for Biotechnology InformationU. Am J Prev Med. Author manuscript; available in PMC Dec 1. Kristi L. ArenaPhD, M. BunkerPhD, Robert L.
HansonMD, Sandra L. ZmudaPhD, Barbara V. HowardPhD, and Andrea M. KriskaPhD. Author information Copyright and information Disclaimer. Address correspondence and reprint requests to: Kristi L. Copyright notice. The publisher's final edited version of this article is available at Am J Prev Med.Days indian adult personal on i 40
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