Physical Activity

缺乏运动和肥胖是大多数美国印第安人和阿拉斯加原住民社区的主要担忧， 特别是考虑到他们越来越久坐不动的生活方式，对机动车和现代便利设施的依赖* 以及土著青年和成年人中日益流行的肥胖症。缺乏体力活动和体力活动 成年人的健康水平与体重无关，与几种不利的健康后果有关，包括 糖尿病和心血管疾病。因此，缺乏体力活动可能是一个重要的可修改因素 解释美洲印第安人和阿拉斯加原住民糖尿病和心血管疾病的高发病率 社区。因此，这项研究的主要目标是确定以社区为基础的 关于身体活动水平的健康计划，并选择久坐和 居住在西雅图大都市的超重/肥胖的美国印第安人和阿拉斯加原住民 区域。本研究中的运动干预部分将基于开发和 在我们之前对非土著成年人的研究中成功地实施了这一方法。因此，我们将修改 采取干预措施，使其在文化上对土著社区作出更多反应，部分基于重点群体和 将在本项目出口的最初几年进行的其他形成性研究。我们的特定 目的是：1)进行一项随机对照试验，测试以社区为基础的健康方案的有效性 为久坐和超重/肥胖的中年美洲印第安人增加体力活动计划 和阿拉斯加土著成年人，2)确定增加体力活动对选定的健康结果的影响， 包括体重指数、腰围和空腹血液指标(血糖、胰岛素、血脂和 高敏的C反应蛋白)，以及3)检查建筑环境和 遵守规定的体力活动水平。我们假设参与者被随机分为一组 以社区为基础的健康计划将有更多的体力活动和更好的健康结果， 例如，腰围和空腹血液指标的下降幅度比一般健康人群更大 教育计划和居住在步行指数较高的社区的参与者更合规 与那些居住在步行指数较低的社区的人相比，规定的运动量水平更高。这个 调查人员将与西雅图印第安人健康委员会和部落长老合作设计干预措施。我们 还将在针对多个层面的生态框架的背景下管理干预 行为改变(例如，个人和社区)。将通过以下方式促进参与干预 社区场所，如老年人团体、教堂、娱乐中心和工作场所。这种方法是 旨在将参与者与他们所在的社区联系起来，以进一步打破障碍 体力活动。它应该特别吸引当地社区团体、卫生保健组织和 政策制定者认为，这一结果很容易推广，并可用于实践。

Physical inactivity and obesity are major concerns in most American Indian and Alaska Native communities, especially given their increasingly sedentary lifestyles, reliance on motor vehicles and modern conveniences* and the growing epidemic of obesity among Native youth and adults. Low physical activity and physical fitness levels in adults, independent of body weight, are linked to several adverse health outcomes, including diabetes and cardiovascular disease. Physical inactivity is thus likely one important modifiable factor explaining the high rates of diabetes and cardiovascular disease in American Indian and Alaska Native communities. Accordingly, the primary objective of this research is to determine the effects of a communitybased health program on physical activity levels and select health outcomes in sedentary and overweight/obese, middle-aged American Indian and Alaska Native adults living in the Seattle metropolitan area. The exercise intervention component in the present study will be based on a program developed and successfully implemented in our previous studies with non-Native adults. We will, therefore, modify the intervention to make it more culturally responsive to Native communities based, in part, on focus groups and other formative research that will be conducted during the early years of this Project EXPORT. Our Specific Aims are to 1) conduct a randomized, controlled trial testing the efficacy of a community-based health program for increasing physical activity in sedentary and overweight/obese, middle-aged American Indian and Alaska Native adults, 2) determine the effects of increasing physical activity on select health outcomes, including body mass index, waist circumference, and fasting blood measures (glucose, insulin, lipids, and high-sensitive c-reactive protein), and 3) examine the relationship between the built environment and compliance with the prescribed level of physical activity. We hypothesize that participants randomized to a community-based health program will have greater increases in physical activity and better health outcomes, such as greater decreases in waist circumference and fasting blood measures than those in a general health education program and participants living in neighborhoods with a higher walkability index be more compliant with the prescribed level of exercise than those living in neighborhoods with a lower walkability index. The investigators will partner with the Seattle Indian Health Board and tribal elders to design the intervention. We also will administer the intervention in the context of an ecological framework targeting multiple levels of behavior change (e.g., individual and community). Participation in the intervention will be facilitated through community sites such as elder groups, churches, recreation centers, and work places. This approach is intended to connect participants to the communities in which they live to further break down barriers to physical activity. It should be especially appealing to local community groups, health care organizations, and policymakers because the results would be readily generalizable and transferable to practice.