The 'Niu Movement' - Effectiveness and acceptability of circuit based exercise in Pacific Islands communities

Abstract

Background For Pacific communities, while health is a collective responsibility, the ability of an individual to contribute to communal obligations can enhance health outcomes. Physical activity is a key component of optimal health. A culturally responsive and sensitive community exercise program is important for increasing levels of physical activity, and thus the positive benefits, within Pacific peoples. Forming meaningful partnerships between communities and research groups may enhance the longevity and acceptability of physical activity programs. The purpose of this study was to document the process, efficacy and acceptability of an exercise program, the ‘Niu Movement,’ for use in Pacific communities. It is the first formal investigation of the use of Cook Islands dance (aerobic component) and coconut cream preparation (resistance component) as a physical activity initiative. Additionally, the research utilised the ‘Tivaivai Research Methodology’ to ensure that Pacific, and more specifically Cook Islands, perspectives were central to research decisions made. Methods The ‘Niu Movement’ was developed by researchers in partnership with Pacific communities. Extensive consultation was conducted with Pacific Trust Otago, Te Marae Ora (Cook Islands Ministry of Health), Church ministers and community leaders within Dunedin, New Zealand and Rarotonga, Cook Islands. These consultations provided for approval of the exercise modality, methods of measurement, the research team and recruitment methods before any formal investigation commenced. Both sites utilised recruitment via posters at community centres and presentations and community functions. At baseline and post-intervention participants underwent basic anthropometric assessment (height, weight, waist and hip circumference); blood pressure; physical capacity (six-minute walk test - 6MWT); and function (the short physical performance battery - SPPB); and a questionnaire of program acceptability. Energy expenditure associated with the Niu Movement program was also collected using the SenseWear Pro Armband (SenseWear Pro Armband - BodyMedia, Pittsburgh, PA), in a single session after program familiarisation. The program was tested for acceptability and suitability as a pilot study conducted in Dunedin, New Zealand and conducted on a larger scale later in Rarotonga, Cook Islands. Both locations utilised the same methodology. Each study was a pre- post quantitative design; within group mixed-model regression comparing baseline and post measures in both cohorts were applied using STATA (Stata Data Management – IDRE Stats – UCLA). Results Twenty-eight Pacific participants (age: 32±15.3, female: 68%) completed baseline and post-intervention testing for the eight-week pilot protocol (Dunedin) and 93 Cook Islands participants (age: 41.1±14.1, female: 91.4%) completed the 12-week protocol (Rarotonga). No adverse events of any kind were reported during either protocol. Energy expenditure data suggested the program to be low-moderate intensity. Dunedin and Rarotonga, revealed significant mean reductions in systolic blood pressure (-5.3mmHg and - 8.9mmHg, respectively), waist (-3.1cm and -3.2cm, respectively) and hip circumference (-3.5cm and -2.9cm, respectively) and a significant increase in distance covered in 6MWT (+58.6m and +54.6m, respectively). High levels of satisfaction were recorded for enjoyment and willingness to participate in the future (4.9±0.3 and 4.7±0.8, out of a possible 5, respectively). Conclusion The ‘Niu Movement’ findings suggest the program is safe and acceptable within the specific Pacific and Cook Islands communities tested. The results show promise for implementation of the program within Pacific communities throughout the region. Furthermore, the findings suggest there is potential to influence future health promotion initiatives to include more culturally specific and relevant modes of movement.