"Sweet Hearts": A biokinetics primary prevention programme in the South African public health sector: A qualitiative analysis

Includes bibliographical referencesThis minor dissertation is comprised of 3 chapters. The first chapter is a meta-analysis that provides a quantitative summary of data from 10 community-based physical activity interventions across 5 countries. The analysis provides evidence for the efficacy of physical activity interventions (standardized mean difference (SMD) = 1.275; percentage increase in physical activity = 29.5%) in increasing levels of physical activity. These findings support the notion that multi-strategic community-wide interventions are able to reach a large proportion of the population regardless of social class and socioeconomic level. Broad-based instead of individual interventions are more cost-effective and help to spread knowledge about the importance of physical activity, stress reduction and nutrition, thereby improving health. The second chapter details the effect of a 3-month pilot Biokinetics primary prevention program ("Sweet Hearts") on health outcome measures. A total of twenty-seven exercise sessions, combined with nutritional advice and stress reduction techniques, were conducted. Despite a small sample size (n = 10), the intervention showed significant improvements in health outcome measures amongst participants (p ≤ 0.05). These improvements include: a decrease in waist circumference and resting respiratory rate, as well as an increase in 1-minute time perception, Global Physical Activity Questionnaire (GPAQ) score, 12-minute walk distance and sit-to-stand test repetitions. Improvements were also noted in cognitive restraint with regards to eating behaviour as well as heart rate variability (HRV), specifically in the low frequency spectrum. The combination of lowered resting breathing rates and improved HRV measures suggests that participant's autonomic nervous system (ANS) regulation improved during the course of the intervention. Correlational analysis revealed that higher income levels were associated with poorer HRV measures. The favourable results of the community intervention show promise for the future expansion of the program into the public health sector and provide proof of concept to dedicate resources to conduct more robust research within a community setting. The final chapter uses a mixed methods approach to explore factors promoting participation and predicting adherence to a community health intervention. The qualitative interviews conducted during this study offers rich and valuable information on how to improve the "Sweet Hearts" intervention. Five main themes were identified from the interviews conducted: 1) Enjoyment of the intervention 2) Benefits of the intervention 3) Obstacles affecting adherence 4) Future improvements to the intervention 5) State of non-communicable diseases in South Africa. Quantitative analysis showed that superior ANS regulation in participants at baseline was indicative of higher attendance rates. This improved regulation is evident through lowered systolic blood pressure and the ability to better regulate (attenuate an increase in) both breathing rate and HRV (low frequency power) from Rest to the Stroop Task s. The detail collected within this analysis will be incorporated into an updated conceptual model that will then form the basis of improving adherence and ensuring the intervention grows from strength to strength in coming years. South Africa is without a focused approach to reduce physical inactivity. The primary function of a Biokineticist is to improve physical functioning and health through exercise as a modality. An alarming number of non-communicable diseases (NCDs), such as cardiovascular disease and type-2 diabetes mellitus, were attributable to physical inactivity among South Africans based on the 1998 South African Demographic and Health survey data. The findings of this dissertation advocate for the support and funding of community-based physical activity interventions in combatting NCDs. The time has come for South African policy makers to act upon the Strategic Plan for Prevention and Control of NCDs (2013-2017). Such action should be A) the inclusion of Biokinetics into the public health sector and B) funding of multi-disciplinary community health programs supporting education, healthy eating and physical activity levels