Physical activity and Aboriginal and Torres Strait Islander People in Australia

Background Globally, non-communicable diseases (NCDs) such as cardiovascular disease and diabetes represent an issue of epidemic proportion, responsible for tens of millions of premature deaths annually. NCDs are also responsible for reducing quality of life and causing detrimental social and economic effects. Disparities across population groups are evident. In Australia, NCDs were a leading cause of the total burden of disease in 2011. Aboriginal and Torres Strait Islanders have a shorter life expectancy and poorer health risk factors and outcomes than non-Indigenous Australians. Much of this gap in life expectancy has been attributed to preventable NCDs. Physical activity is a key modifiable cause of the excess burden of disease and mortality. Among Aboriginal and Torres Strait Islanders, there is a lack of evidence around the associations between physical activity and health and demographic factors and the impact of strategies to increase physical activity, compared to mainstream evidence. Aims This thesis aims to contribute towards building an evidence base around the association of physical activity on the health of Aboriginal and Torres Strait Islanders. The first aim is to examine cross-sectional associations between physical activity and a range of lifestyle, environmental and social factors among adults. Subsequently, the thesis identifies and describes physical activity patterns and influencing factors among adolescents. The third aim is to describe characteristics of physical activity programs targeting Aboriginal and Torres Strait Islanders. Lastly, the thesis aims to measure the effects of a community-based physical activity program. Methods The series of studies used a range of methods. The first study examined whether achievement of national physical activity recommendations was associated with healthy lifestyle behaviours, neighbourhood environmental characteristics and social support among Aboriginal and non- Aboriginal adults in New South Wales (NSW) (Chapter 2). The second study examined cross-sectional demographic, social, psychosocial and health correlates of physical activity among Aboriginal and non- Aboriginal adolescents in NSW (Chapter 3). The third study examined age related declines in physical activity among Aboriginal and non-Aboriginal young people and their variation by season, setting and type among Aboriginal and non-Aboriginal children from between 2007/8 and 2011/12 (Chapter 4). The fourth study reviewed the scientific and grey literature for physical activity programs targeting Aboriginal and Torres Strait Islanders operating between 2012 and 2015, described their characteristics and engaged with program coordinators to verify sourced information (Chapter 5). The final study examined the health and community impacts of the Indigenous Marathon Program (IMP) in a remote Torres Strait island community, using questionnaire and semi-structured interview mixed methods (Chapter 6). Results In Chapter 2, a similar proportion of Aboriginal and non-Aboriginal adults achieved national physical activity recommendations and factors relating to achieving recommendations were similar in both groups. However, neighbourhood features and social support were less favourable among Aboriginal adults. Among Aboriginal and non-Aboriginal adolescents, physical activity levels were similarly low but some correlates differed by Aboriginality (Chapter 3). Aboriginal girls were less active than boys, as were those whose mothers were unemployed. In Chapter 4, serial physical activity declines were found in a population of Aboriginal and non-Aboriginal young people over five years, but not across all seasons, settings and types. Chapter 5, identifies 110 programs that aimed to increase physical activity for health or broader social outcomes. Around half were found to collect process or impact evaluation data but this is underrepresented in the scientific literature. In Chapter 6, impacts of Indigenous Marathon Program were the adoption of running and broader healthy lifestyle factors in a remote community with a high initial level of community readiness. Barriers to running were both personal, cultural and environmental. Conclusion The findings from this thesis make a novel contribution to building an evidence base of associations between physical activity and the health of Aboriginal and Torres Strait Islanders. A number of factors associated with physical activity in adults and children are unique to Aboriginal and Torres Strait Islanders populations; other factors are similar to those experienced by mainstream populations. It is vitally important that physical activity programs that aim to improve health or social outcomes can determine their value through evaluation