Review and special article
Physical Activity and Native Americans: A Review

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Abstract

The physical activity behaviors of Native-American populations in the United States and Canada have received little attention in the health literature. The purpose of this review was to unite the literature regarding the physical activity behaviors of Native Americans. A majority of the literature was obtained using online databases. Reference lists were also reviewed to gain further access to the literature. Key-word searches included various combinations of Aboriginal, Native Indian, American Indian, Native American, First Nation, Métis, or Alaska Native with physical activity, exercise, and health behavior. Articles included were those published in English-language, peer-reviewed journals from 1990 until November 2005 that focused on participants aged 18 years and older. This review is organized according to ecologic models of health behavior, which take into account several correlates to explain human behavior, including demographic, personal health, environmental, and psychosocial. Correlates were included if they appeared at least three times in the literature. As a result of these inclusion criteria, the number of reviewed articles includes 28 quantitative, 4 qualitative, and 3 intervention studies. Results indicate that age, gender, and social support are important factors associated with physical activity. The remaining correlates show inconsistent or indeterminate results due in part to the paucity of research. It is suggested that an increase in the number of studies, especially those using longitudinal designs, is needed. Further, the application of psychosocial models to understand physical activity motivations as well as culturally appropriate and validated measurement tools are largely absent in the Native-American physical activity literature.

Introduction

Regular physical activity (PA) and its association with increased health benefits have been well documented.1, 2, 3 It was evident that even moderate increases in PA are associated with various health benefits especially in previously sedentary individuals.1 Recent research suggests that quality of life is greatly enhanced in adults regardless of age and state of health.4 Unfortunately, 56% of Canadian adults and more than 60% of American adults do not engage in enough regular PA to achieve optimal health benefits.1, 5

Among the least-active segments of the North-American population are ethnic minorities.6, 7, 8 Despite the PA disparities between minorities and their nonminority counterparts, there have been relatively few studies that document the health and PA behaviors of Native Americans.9, 10, 11, 12 The few studies that do exist have shown less-than-optimal PA levels.9, 10, 13, 14 For example, the U.S. Department of Health and Human Services15 indicates that 46% of Native Americans report no leisure-time PA compared to 38% of their nonminority counterparts.

It was suggested that a change in the traditional lifestyle of Native Americans has had a large impact on their current health.16, 17 Indeed, Native-American women from the United States recognize that current generations have very different eating habits and do not engage in daily activities characteristic of past generations.18 Currently, many Native-American communities have either high or increasing rates of obesity,19, 20, 21 type 2 diabetes,22, 23, 24 and cardiovascular disease.25, 26, 27 Research has shown that increased levels of PA in Native Americans are positively associated with increased lipoprotein levels, specifically, high-density lipoprotein cholesterol and apolipoprotein AI, which have a protective effect against coronary heart disease,28 and are inversely associated with fasting insulin levels,29, 30 lower mean body mass index (BMI) levels, and percentage of fat and fat mass.31, 32

There is a need to improve the PA habits of the Native-American population to reduce the risk of disease and premature death. Previous PA research has often focused on those factors or correlates that determine PA habits. The most commonly studied correlates of PA are generally divided into two categories: those considered modifiable, such as economic status, education, personal traits, social support, or environmental situation, and those considered immutable, such as age, gender, and ethnicity.33 Determining the strength of the interactions between various correlates and PA are the integral first steps to promoting a physically active lifestyle and improved health.4 To date, no research has attempted to review the correlates of PA in Native-American men and women.

Considering the current state of Native-American health and the beneficial effects of regular PA, a review of the correlates of PA in Native Americans was warranted. The purpose of the following narrative review was to unite the literature on PA and Native Americans from the United States and Canada.

Section snippets

Methods

The majority of the literature was obtained using online databases including PubMed, ERIC, PsychInfo, MEDLINE, Web of Science, CINAHL, and Health Source: Nursing/Academic Edition. Reference lists of identified articles were reviewed to increase access to the relevant literature. For the purpose of this review, “Native American” will be the term used to describe all populations indigenous to the United States and Canada. Key-word searches included various combinations of Native American, Native

Results

Table 1 highlights studies that have quantified the relationships between potential correlates and PA. As such, intervention studies, qualitative studies, and portions of those quantitative studies that used free-response questions, such as those related to describing barriers to PA, are not included. These studies, however, are included as a part of the results and conclusion.

Conclusion

The purpose of this review was to unite the literature concerning Native-American populations and PA. The focus was on the correlates of PA behavior and psychosocial theories, as well as interventions to increase PA. The most important finding of this review was how very little is known about the PA behaviors of Native Americans. It is prudent to highlight that although many of the associations were not unique to Native Americans, they should be considered indeterminate until more research can

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