2012 (Feb 8-10) Integrated Chronic Disease Prevention: It Works! CDPAC Fourth Pan-Canadian Conference, presentation by BRAID Research and Driftpile First Nation

1. Fitness Improvements among children
in one Alberta First Nation
BRAID-Kids
BRAID Prevention of Obesity and Diabetes in
Children and Families (BRAID-Kids)
Paulette Campiou, Diabetes Coordinator, Driftpile First Nation
Dr. Ellen Toth, Principal Investigator, University of Alberta

2. BRAID = Believing we can Reduce Aboriginal Incidence of Diabetes
ORIGINAL BRAID STUDY (2003-2006)
Collaboration between Driftpile and the University of Alberta.
Screened the population of Driftpile for undiagnosed diabetes (including
children)
Screening results in 89 children and adolescents:
Community wanted to work on PREVENTION, involving children and their
families
Pre-diabetes 27%
Probable diabetes 1.2%
Overweight 22%
Obese 44%

3. Setting:
DRIFTPILE CREE NATION is 350
kms northwest of Edmonton,
Alberta, on the shores of Lesser
Slave Lake
Driftpile has approximately 1600
Band Members, of whom about 850
live on reserve land.
Driftpile is home to approximately
200 children and adolescents ages
5-17.

4. BRAID-Kids STUDY DESIGN
BRAID-Kids was based on the Kahnawake Schools
Diabetes Prevention Program (KSDPP) and the Sandy
Lake diabetes prevention program, and used educational
materials and assessment tools developed by these
programs.
However, BRAID-Kids planned to have an improved
study design – Cree Pride – based on Pima Pride: a “de-
colonizing” project where exposure to Pima tradition and
culture improved diabetes control (Narayan, 1998)

5. BRAID-Kids & Cree Pride
BRAID
(original
study)
Pima
Action /
Pima
Pride
KSDPP
(Kahnawake) Sandy Lake
DPP

6. BRAID-Kids
Hypothesis: Decolonization may enable First Nations families to avoid
behaviors that contribute to obesity and diabetes risk.
Primary Outcome: assess physical activity and dietary choices amongst
children, by:
Measuring clinical, anthropometric and fitness outcomes of
participating children near the beginning and end of each school year;
Administering a food frequency and physical activity questionnaire
Implementing an in-classroom diabetes prevention curriculum;
Implementing a tradition-based “Cree Pride” program aimed at
parents/guardians/families.

7. Mihtatakaw Sipiy (ELEMENTARY) School,
DRIFTPILE FIRST NATION
Built in the shape of an eagle feather

8. RESULTS:
Recruitment: 89 children and their families were recruited, but this
took 2 years
Fitness assessments and risk assessments were conducted near
the beginning and end of the school year.
BRAID-Kids Project Dietitian visited the school and the community
regularly
The Cree Pride intervention component was developed as 6-10
sessions but it was not implemented, due to competing activities
and programs being carried out by the community, the recreation
department, the health center and school;
.

9. Baseline clinical, anthropometric for all children measured by BRAID-Kids, N=89
MEASUREMENT RESULTS
Gender, % female 42 (47.2%)
Mean age, years 8.2 (range: 4-15)
Fasting glucometer blood glucose, N=59
Mean (mmol/L) 5.4 (range: 4.3-7.8)
“Possible” diabetesa, # of children (%) 1 (1.7%)
“Possible” pre-diabetesb, # of children (%) 7 (11.9%)
Body Mass Index (BMI), N=87:
≥85th-<95th, overweightc, # of children (%) 18 (20.7%)
≥95th, obesityc, # of children (%) 43 (49.4%)
Central adiposityd, N=88, # of children (%) 74 (84.1%)
Hypertensione, N=60, # of children (%) 14 (23.3%)
a. fasting blood glucose ≥7.0 mmol/L; b. fasting blood glucose 6.1-6.9 mmol/L; c. CDC percentile reference for age and gender; d. NHANESIII: central adiposity
= waist circumference ≥85th percentile for age and gender; e. CDC percentile reference for age and gender, hypertension: ≥95th percentile;

10. Fitness Testing:
 20m Multi-stage Shuttle Run “beep test” (Leger, 1984, 1988)
 Measures “maximal oxygen uptake”, which indicates aerobic fitness.
.

11. Fitness percentiles for age and gender, N=86a
Gender (% female) 37 (43.0%)
Mean Age (years) 9
Fitness: percentile for age and genderb
, N = 86
# of children < 5th percentile (percent) 58 (67.4%)
# of children 5th to <10th percentile (percent) 8 (9.3%)
# of children 10th to <20th percentile (percent) 9 (10.5%)
# of children 20th to <30th percentile (percent) 5 (5.8%)
# of children 30th to <40th percentile (percent) 1 (1.2%)
# of children 40th to < 50th percentile (percent) 3 (3.5%)
# of children 50th to <60th percentile (percent) 2 (2.3%)
# of children below 20th percentilec
(percent) 75 (87.2%)
Baseline Fitness results for children who underwent fitness
testing by BRAID-Kids
a. children under the age of 6 were excluded, per Leger reference (Leger, 1984)
b. (Leger, 1984)
c. relative fitness = >20th percentile (Downs, 2006)

12. RESULTS AFTER ONE YEAR
We looked at changes for children who had repeat tests
undertaken after a 1 year interval:
Significant improvements in fitness scores (in age-and-
gender percentile rank and VO2 Max)
No differences in glucose, weight, waist or BP except for an
increase in the % of children with diastolic (but not systolic)
hypertension
*
BASELINE RESULTS
Baseline results were once again consistent with our very high
rates of overweight and obesity and very low levels of fitness
reported for some First Nations communities.

13. Mean improvements in age-and-gender percentiles for children
tested at 1 year intervals (Leger, 1984), N=19
* p < 0.01 from paired t-test

14. Mean VO2 Max values for children tested at 1 year
intervals (n = 24)
* p < 0.01 from paired t-test

15. INTERPRETATION
Observed improvements in fitness are likely not a direct result of BRAID-
Kids alone:
A new physical education program with a specific gym teacher at
the school was very helpful
Because of regular “beep tests” in gym class, children became
practiced at test procedures
Increased surveillance communicated a focus on fitness to
children and their families.
Since many Band Councils control their community’s education
budget and policies, our results may be helpful information for
Leadership decision-making.

16. IN SUMMARY
Positive things are happening:
Some families report having changed their eating
habits.
BRAID-Kids Project Dietitian visiting Driftpile regularly.
Full-time school gym teacher.
numerous community efforts at promoting prevention
and healthy living; and,
CREE PRIDE

18. Driftpile Cadets

19. Driftpile Youth Baseball

20. Traditional Hand Games

21. Acknowledgements:
Lawson Foundation
Alberta Center for Child Family and Community Research
Chief Rose Laboucan
Health Director Florence Willier
Research assistants:
Trina Scott
Tessirae Sasakamoose
Priscilla Lalonde
U of A support: Kelli Ralph Campbell
Dietitian: Kari Quinn