Exercise as it relates to Disease/Strategies to increase physical activity in Samoan communities

This is Wiki review of the journal article: A nutrition and exercise intervention program for controlling weight in Samoan communities in New Zealand by Bell et al. (2001)

What is the background to this research?
Samoans are considered one of the most obese populations in the world. Previous studies have investigated the connection between migration, changing of diet, and less physically demanding jobs to the increased chances of mortality and chronic diseases, such as obesity, diabetes and cardiovascular disease.

The large majority of research has been conducted with Samoan church communities in New Zealand. Researchers have acknowledged that with migration, the church has replaced the role of the village and become the centre point and social hub of the community.

The objective of the Samoan Ola Fa’autauta (Life Wise) Study was to conduct a nutrition and exercise intervention to promote weight loss in Samoan church communities in Auckland.

Where is the research from?
The study was carried out by a team of researchers from the Faculty of Medicine and Health Science at the University of Auckland, who were supported by the Health Research Council of New Zealand and the Pacific Islander Heartbeat, a program run by National Heart Foundation of New Zealand. The study was published in the 2001 International Journal of Obesity.

What kind of research was this?
The Samoan Ola Fa’autauta Study used a quasi-experimental study to assess weight change. A quasi-experimental study can be defined as research that aims to evaluate interventions without the use of randomisations. Researchers chose this type of design so that the Otara church (the largest of the three churches) was non-randomly selected to receive the one year intervention activities, while the two smaller churches acted as control groups.

What did the research involve?
The study involved 609 adults who were 20 years old and over. The participants were required to have their height, weight, waist and hip circumferences measured, complete a diet and life style questionnaire and have their physical activity levels assessed. A diet and life style questionnaire was used to understand the participants’ nutritional knowledge and healthy habits. The questionnaire assessed the following:

•	Participants’ knowledge of the fat content in 23 commonly consumed foods

•	Frequency of green vegetables consumed during dinner

•	Frequency of fat from meats was removed

•	Frequency skin from chicken was removed

•	Frequency coconut cream was diluted

Participants’ physical activity levels were assessed by determining whether they were moderately or vigorously active during leisure time in a normal week. Brisk walking and other similar activities were considered a moderate level of physical activity, while activities causing the participant to sweat or breathe heavily was classified as a vigorous level of physical activity. For the participants who did not undertake any exercise or didn’t meet the criteria of moderate physical activity they were classified as sedentary.

The main aim of the intervention group was to lose weight. The intervention consisted of three main components:

1.	Encourage a low fat diet Encouragement of a low fat diet was conducted in the form of one hour nutrition education sessions delivered to participants, their families, caterers and the whole church congregation. The sessions advised dietary recommendations based on the healthy food pyramid and demonstrated fat lowering techniques and alternatives.

2.	Increase physical activity Creation of walking groups and weekly aerobic sessions were established to encourage physical activity. Aerobic sessions were conducted by the Pacific Islander Heartbeat and scheduled around normal church gatherings.

3.	Train church members to become leaders of nutrition education and aerobic sessions. Church members were selected to participate in training sessions to gain accreditation in nutrition education and aerobics fitness. It was hoped that the accredited church members would be able to lead nutrition education and aerobic sessions without the assistance Pacific Islander Heartbeat after the study was completed.

What were the basic results?
•	Weight loss for intervention group: Mean of 0.4 kg loss

•	Weight gain for the control group: Mean of 1.5 kg was gained

•	Decline in hip circumference for intervention group: Mean of -0.5 cm

•	Increase in hip circumferences for the control group: Mean +2.1 cm

•	No significant change in waist circumference or blood pressure

•	Results after maintenance year

o	Weight that had been lost during the intervention year was regained

o	Increase in sedentary participants

o	Decrease in moderately active participants

o	Increase of people diluting coconut cream

How did the researchers interpret the results?
The researchers interpreted the results of the study by concluding that one year of nutrition and exercise intervention was beneficial in stalling weight gain and encouraging a number of people to increase physical activity intensity from moderate to vigorous. The results also acknowledged positive changes in blood pressure and the continuation of physical activity after the study.

What conclusions should be taken away from this research?
The current trend is that Samoan communities are very obese and vulnerable to weight gain and this likely to continue unless there is drastic changes. Better nutrition and an increase in exercise have proven to achieve weight loss. However several areas were identified that still needs to be addressed such as maintaining weight loss, Samoans community’s cultural beliefs about food, sedentary behavior and continual increase in weight gain despite the pre-existing adiposity.

What are the implications of this research?
The research indicates that the implementation of a nutrition and exercise intervention in Samoan communities is proven to have health benefits. An increase in physical activity and better nutrition can decreases chances of mortality and reduces the likelihood chronic diseases, such as obesity, diabetes and cardiovascular disease.

However, despite the good intentions of the researchers and the benefits associated with the interventions, the Samoan community need to take greater responsibility in addressing the serious health issues in their population. Adequate changes that could be made include a cultural shift in the role of food in traditional customs, promoting the intake of traditional foods and greater leadership within Samoan communities to promote healthier and more active lifestyles.

Future interventions needs to ensure that any healthy weight loss and participation in physical activities is preserved over a lifetime.