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Key Points:
• Pacific peoples in New Zealand are significantly less active than the rest of the New
Zealand population.
• Physical inactivity is a significant risk factor for diabetes.
• Physical activity is defined as 30 minutes of moderate-intensity activity on most if not all
days of the week.
• The benefits of increasing physical activity levels among Pacific peoples can reduce the
onset and prevalence of diabetes.
• Pacific people’s concepts of physical activity and exercise in the New Zealand setting may
be a barrier to increasing physical activity levels.
• Physical activity interventions must take into account politico-economic and social policies
along with more direct barriers such as time, financial constraints, language, knowledge,
other responsibilities (e.g. church, family), motivation and fear of change.
• Re-focusing or re-defining mainstream physical activity interventions to tailor Pacific
needs is important.
• Developing adequate ‘Pacific specific’ physical activity resources that support existing
Pacific physical activity programmes that are based around visual mediums.
• Providing sound education and increasing the number of Pacific physical activity
leaders is essential to bridging the gaps in ‘Pacific specific’ physical activity and lifestyle
programmes.
Table 1. Catergories of Physical Activity / Inactivity. Adapted from MoH DHB Toolkit:
Physical Activity 2003.
Active / Inactive Category Description
Physically active Relatively active Took part in at least 2.5 hours of leisure time
PA in the previous seven days
The Hillary Commission (now SPARC) developed physical activity guidelines for adults (table
2) which are very similar to current worldwide thought (Kriska, 2002). In addition to these
recommendations, SPARC recommends that children and adolescents should do three 20 minute
Table 2. Hillary Commission Physical Activity Guidelines for Adults. Adapted from
DHB Toolkit: Physical Activity 2003.
• View movement as an opportunity, not an inconvenience.
• Be active every day in as many ways as possible.
• Put together at least 30 minutes of moderate-intensity physical activity on most, if not all,
days of the week.
• If possible, add some vigorous exercise for extra health and fitness
Specific concepts have emerged from the campaigns used to get the recommendations into the
wider community. Snacktivity is one such concept. Research has shown that moderate-intensity
physical activity broken up into parts of 30 minutes, such as 3 lots of 8-10 minutes, can have the
same effect as a continuous bout of moderate-intensity physical activity (MoH, 2003).
The manner in which one achieves these physical activity targets is endless. These recommendations
are a minimum and figure 1 below illustrates how more vigorous activity in less time is equivalent
to low intensity activity of longer duration. Table 8 in the resource section gives specific day to
day examples of low, moderate and vigorous physical activity.
Figure 1. Ways of meeting the moderate physical activity guidelines (in daily life).
Adapted from DHB Toolkit: Physical Activity 2003.
• Washing & waxing a car for 45-60 minutes LESS vigorous, More time
• Washing windows or floors for 45-60 minutes
• Playing volleyball for 45 minutes
• Playing touch rugby for 30-40 minutes
• Gardening for 30-45 minutes
• Wheeling self in wheelchair for 30-40 minutes
• Walking 2.8km in 35 minutes (12.5 min/km)
• Basketball-shooting baskets for 30 minutes
• Bicycling 8km in 30 minutes
• Dancing fast (social) for 30 minutes
• Pushing stroller for 30 minutes
• Raking leaves for 30 minutes
• Walking 3.2km in 30 minutes (9.5 min/km)
• Water aerobics for 30 minutes
• Swimming laps for 20 minutes
• Skipping for 15 minutes
• Running 2.4km in 15 minutes (6.3 min/km)
MORE vigorous, LESS time
• Climbing stairs for 15 minutes
The ‘Living4Life’ programme is a specially developed programme aimed at year 9 students. It covers
health promotion to prevent diabetes/obesity and make healthy choices, and a motivational physical
activity programme. Each school chooses how the programme is set up but essentially there are 10
x 1 hour interactive teaching sessions over the year, and some schools prefer breakfast type activity
programmes, or several times a week lunchtime activity sessions.
Currently ‘Living4Life’ is targeted at three AIMHI South Auckland secondary schools - Mangere,
Southern Cross and Hillary College. The programme is led by Judy Rowden and Lama Saga. Funding
is from CMDHB, under the umbrella of the newly launched ‘Lets Beat Diabetes’, and it is monitored by
the NEW (Nutrition, Exercise & Weight) working party.
Judy delivers the teaching sessions, and Lama is the key Activity instructor. Activities range from
using activity contractors (e.g.Manukau on the Move - for Kayaking, TV celebrities), resistance classes,
playing the more popular sports or games (volleyball, touch rugby,
kilikiti), going for hikes and the very popular Hip Hop dance offs (Mangere College won the Auckland
Hip Hop contest! In 2005).
This programme initially started as an unfunded trial in one school but escalated and subsequently
gained some direct funding. These activity sessions have proven to be very popular, with some
sessions having 50 - 60 kids participating. The essential aspects of the physical activity components
are participation, fun and doing activities the young people want to do while reinforcing the overall
messages delivered in the health promotion sessions.
• Lack of resources
• Cultural issues
• Pride
Specific barriers to physical activity itself are well recognised. These are listed below (Table 5).
Table 5. Barriers to Physical Activity. Adapted from MoH DHB Toolkit: Physical Activity
2003 & SPARC; Obstacles to Action: A Study of New Zealanders’ Physical Activity and
Nutrition 2004
• Time
• Other responsibilities
• Fear of failure
• Language
• Injury or disability
• No motivation
• Poor health
While the Pacific population may differ in terms of barriers to physical activity, it is clear that the
Interventions that are aimed at lifestyle changes in particular increasing Pacific people’s physical
activity patterns must acknowledge the above barriers and provide solutions to overcome these
barriers.
Mary Patana leads the ‘Pacifica Aerobics’ activity sessions, which are based in 3 locations around
South Auckland, Mangere, Clendon and Otara (above). She has a passion for her peoples’ health
and wellbeing.
The ‘Pacific Aerobics’ sessions are held five days a week. Attendances have grown dramatically since
the programmes inception. It is not out of the ordinary to have more than 50 participants or any given
day. It really is a social gathering with physical activity on the menu.
This programme was set up to get their (Health Pacifica) diabetic population physically active. It
proved to be very popular and was rapidly expanding in terms of numbers attending sessions. They
have approximately 25 diabetics who regularly attend the physical activity sessions. These patients
are managed under the CCM (Chronic Care Management) plan and are reviewed on Health Pacific’s
premises. Everyone is encouraged to regularly attend, while educational messages such as nutrition,
hydration and diabetes monitoring are conveyed during the activity sessions. People are encouraged
to weigh themselves, with around 5- 10% of those attending choosing to do so. The physical activity
session itself follows a standard slow warming up phase, some more vigourous aerobics / pacific style
dance moves, followed by a slowing down up period.
Mary is undergoing further tertiary education at present to enhance her knowledge around physical
activity delivery and sees access and education as some of the bigger barriers that face the Pacific
populations.
ACC SportSmart: 10 point plan for injury prevention, injury prevention kit
for schools (Te Kaupapa Arai Whara) (health resource, through the marae),
falls prevention demonstration projects
Local government Recreation and sports facilities and a variety of directly provided or funded
recreation programmes for all ages, Safer Community Councils, Healthy
Cities, design of urban environments in ways that encourage incidental
physical activity
Public health services, Healthy Cities, nutrition and physical activity teams have strategies that
DHBs include training and workplace programmes, Healthy Schools, Agewell
Ministry of Education/ Health and Physical Recreation Curriculum, tertiary education institutions
education (programmes, gym facilities), clubs
Non-government organisations
National Heart Stroll, Strut, Stride, guidelines for exercise programmes for patients with
Foundation heart disease, Pacific Heartbeat
Agencies for Healthy Weight New Zealand, supports SPARC’s programmes for physical
Nutrition Action activity promotion
YMCA, YWCA A range of gym-based and other physical activity programmes, cardiac
rehabilitation, physiotherapy etc
Most of these intervention strategies have their place and may be utilised by Pacific peoples.
However considerations to the barriers that Pacific peoples face means that many of these
interventions may not be appropriate for Pacific populations. Pacific health providers in primary
care settings have in recent times been able to directly fund and run Pacific specific activity
interventions. This has led to an array of physical activity interventions predominantly Pacific
style aerobics in community or church based settings (CMDHB, 2004).
Table 7. Stages of Change, Stage and Action suggested. Adapted from Duffy &
Schnirring, 2000.
Stage of Change Behaviours Action suggested
Precontemplation Surprise or ignorance when exercise Deliver clear physical activity
is recommended messages
Education on problem, benefits &
support
Contemplation Ambivalence about adopting physical Convince in favour of change
activity, resistance, denial Use community role models &
examples
Determination Patient’s statements reflect concern Help patient find an appropriate
and desire to change physical activity strategies
Offer tools & set goals, encourage
small changes eg. park further
away, play with kids, do housework
Action Commitment to exercise Support patients as they become
more physically active (use family,
elders, olfer siblings & community)
Reinforce achievement, reiterate
support, benefits & goal focus
Maintenance Exercise becomes routine Support patients as they remain
physically active (use family, elders,
olfer siblings & community)
Congratulate, reinforce
achievements, goals & benefits
Relapse Lapses into inactivity patterns Help patient avoid staleness /
demoralisation, help patients
re-evaluate their next physical
activity action steps
Ask why, identify barriers & options
to overcome, ? motivation
Being a rugby player was a huge part of his life, and being a diabetic meant
that he had to have very good understanding of his problem, be able to manage
his blood sugar levels, and understand the importance and benefits that physical
activity had on his health.
Dylan’s concepts of activity are clear, he knows that being physically active is an important part of his
diabetes management, “any kind of activity will do” from simply walking to the shops, or not having
any TV remotes to doing the house cleaning.
Specific diabetes issues that he confronted being a rugby player were making certain he had eaten
correctly before any training, knowing his blood sugar levels before training and having enough
sweet drinks at training – just in case!
His family has played a massive role, “if they didn’t have a very good understanding of diabetes and
its impact on me I would have been in big trouble”. He doubts he would have been a top rugby player
if his family didn’t play such an active role in managing his diabetes with him. Food is especially
important, getting everyone in the family (“and that’s a lot of people where talking about”) eating the
same food not preparing separate special meals for the diabetic person.
Dylan keeps active these days by playing squash, swimming, walking, housework and he still does
weights in the gym every now and again.
7. Push Play
http://www.pushplay.org.nz/files/GRX_Medical.pdf
9. National Center for Chronic Disease Prevention and Health Promotion - Be Active
Kids (Diabetes)
http://www.ndep.nih.gov/diabetes/pubs/Youth_Tips_Active.pdf
10. National Center for Chronic Disease Prevention and Health Promotion - Food and
Activity Tracker (Diabetes)
http://www.ndep.nih.gov/diabetes/pubs/GP_FoodActTracker.pdf
2. NZ Ministry of Health
a. Pacific Health - http://www.moh.govt.nz/pacific
b. Diabetes in NZ - http://www.moh.govt.nz/moh.nsf/
238fd5fb4fd051844c256669006aed57/c882d0d59e75c270cc256c46001186bf?Open
Document
c. Physical Activity http://www.moh.govt.nz/moh.
nsf/238fd5fb4fd051844c256669006aed57/
03a8bf6f49f41e4ccc256ee300787945?OpenDocument
d. DHB Toolkit Physical Activity http://www.newhealth.govt.nz/toolkits/physicalactivity.
htm
e. DHB Toolkit Diabetes http://www.newhealth.govt.nz/toolkits/diabetes/Diabetes.pdf
4. SPARC
a. Home page http://www.sparc.org.nz/
b. Push Play http://www.pushplay.org.nz/
c. Green Prescription http://www.pushplay.org.nz/page.asp?PageID=24
d. Kiwi Sport http://www.sparc.org.nz/whatwedo/yp/kiwisport.php
e. Sportfit http://www.sparc.org.nz/whatwedo/yp/sportfit.php
f. Kiwi Walks http://www.sport.org.nz/kiwiwalks/Search.asp?Region=Auckland&RegionID
=4
g. He Oranga Poutama http://www.pushplay.org.nz/page.asp?pageID=25
6. Heart Foundation
a. Home Page http://www.heartfoundation.org.nz/index.asp
b. Pacific Islands Heartbeat Programme http://www.pacificheart.org.nz/
9. Diaries
a. American Heart Association
» http://www.justmove.org/diary/login.cfm
b. National Heart Lung & Blood Institute
» http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/diary.htm
c. Diabetes.com
» http://www.diabetesmonitor.com/records.htm#glucose
NPDINPDI
Physical Activity
Physical Handbook
Activity Guide
Acknowledgements
National Pacific Diabetes Initiative (NPDI) steering group wish to acknowledge and thank the
following people for their valuable contribution to the development of this lifestyle guide:
• Jordan Salesa, author of this lifestyle guide
• NPDI Lifestyle Guide Team - Linda Mulitalo Tasi, Stephanie Erick-Peleti and Karen
Fukofuka for their support, commitment and dedication to working on this project.
• Josephine Samuelu, Project Manager NPDI and Lincoln Papali’i, CMDHB.
• The team from Intra Pacific Development Trust – Yvonne Timaloa and Karyn Ne’emia
• The regional NPDI summit attendees in Christchurch, Wellington and Auckland for their
feedback and comments.
• Rob Cook – Project Manager from the New Zealand Guidelines Group
• Diana O’Neill from SPARC for critiquing this work.
• Dave Driscoll from the National Heart Foundation for his input in to the physical activity
hand book.
• The Ministry of Health for their vision and commitment to improving health outcomes for
Pacific people.
Section A
Background
The background information for the development for the Physical Activity Guideline is contained
in the Physical Activity Lifestyle Guide document. Information was gathered from individual
interviews with various Pacific Health Professionals and providers around the country. An extensive
literature review of current evidence-based Physical Activity recommendations for people with
type 2 diabetes was also undertaken. Other sources of information included reports from the
stocktaking and mapping exercise undertaken by Lincoln Papali’i and Dr. Catherine Moor.
Adequate Physical activity levels alone will not suffice in the battle against diabetes. The
critical components of the NPDI Framework are clinical intervention, integration and lifestyle
intervention.
To delay the progression of the disease and the development of diabetic complications, these key
physical activity goals need to be addressed:
1. An individual (and or family / community) shift from physical inactivity to one of physical
activity.
2. Accumulation of 30 minutes of moderate-intensity physical activity on most if not all days
of the week.
3. Setting mutual relevant physical activity goals, monitor, follow up and progress these.
4. Maintenance of Physical activity lifestyle.
This handbook is designed to compliment the Physical Activity Guideline (figure 1) and enable
the clinical or practical realisation of the above goals. Underpinning the development of this
handbook (and guideline) was:
• Practicality or simplicity of advice.
• Culturally appropriate advice / information.
• Ease of use.
• Evidence-based.
The Guideline
This section describes the stepwise approach to physical activity guidelines for type 2 diabetic
Pacific peoples. This is an expanded explanation of figure 1, where the figure is meant as a
clinical trigger for the health professional. Again it is important to note that the guideline and
this handbook are not stand alone documents. They have derived from the NPDI Physical Activity
Guide Stage 1 - Background; the NPDI Literature Review and the Evidence-based Best Practice
Guideline: Management of Type 2 Diabetes publications. This handbook must also be applied
along side the smoking cessation and dietary handbooks as well.
Links
Push Play
http://www.sparc.org.nz/
Diabetes New Zealand
http://www.diabetes.org.nz/
Centers for disease control and prevention (CDC)
http://www.cdc.gov
Diabetes Prevention Program
http://www.bsc.gwu.edu/dpp/lifestyle/dpp_acor.html
Ministry of Health (Diabetes Toolkit)
http://www.newhealth.govt.nz/toolkits/diabetes.htm
New Zealand Guidelines Group
http://www.nzgg.org.nz
Canadian Society for Exercise Physiology
http://www.csep.ca/about.asp (PAR-Q & You forms)