1. Fitness Improvements among children
in one Alberta First Na7on
BRAID‐Kids
BRAID Preven1on of Obesity and Diabetes in
Children and Families (BRAID‐Kids)
Narrated by:
Kelli Campbell, Research Assistant / Project Coordinator
Paule=e Campiou, Diabetes Coordinator, Dri?pile First NaAon
Dr. Ellen Toth, Principal InvesAgator, University of Alberta

2. BRAID = Believing we can Reduce Aboriginal Incidence of Diabetes
ORIGINAL BRAID STUDY (2003‐2006)
Collabora7on between Dri;pile and the University of Alberta.
Screened the popula7on of Dri;pile 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. SeRng:
DRIFTPILE CREE NATION is 350 kms
northwest of Edmonton, Alberta, on
the shores of Lesser Slave Lake.
Dri;pile has approximately 1600 Band
Members, of whom about 850 live on
reserve land.
Dri;pile 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
Preven7on Program (KSDPP) and the Sandy Lake diabetes
preven7on program, and used educa7onal 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 tradi7on and culture improved
diabetes control (Narayan, 1998)

5. BRAID‐Kids
Hypothesis: Decoloniza7on may enable First Na7ons families to avoid
behaviors that contribute to obesity and diabetes risk.
Primary Outcome: assess physical ac7vity and dietary choices amongst
children, by:
 Measuring clinical, anthropometric and fitness outcomes of
par7cipa7ng children near the beginning and end of each school year;
 Administering a food frequency and physical ac7vity ques7onnaire;
Interven6on:
 Implemen7ng an in‐classroom diabetes preven7on curriculum;
 Implemen7ng a tradi7on‐based Cree Pride program aimed at
parents/guardians/families.

6. MIHTATAKAW SIPIY (ELEMENTARY) SCHOOL,
DRIFTPILE FIRST NATION
Built in the shape of an eagle feather

7. RESULTS:
Recruitment: 89 children and their families were recruited, but this took
about 2 years.
BRAID‐Kids Project Die77an visited the school and the community
regularly.
In‐classroom curriculum not fully implemented.
The Cree Pride interven7on component was developed as a 6‐10 session
program but it was not implemented, due to compe7ng ac7vi7es and
programs being carried out by the community, the recrea7on
department, the health center and school.

8. Baseline clinical, anthropometric for all children measured by BRAID-Kids, N=72a
MEASUREMENT RESULTS
Gender, % female 47.2%
Mean age, years 7.9 (range: 4-15 years)
Fasting glucometer blood glucose, N=57
Mean (mmol/L) 5.4 (range: 4.3-7.8)
“Possible” diabetesb, # of children (%) 1 (1.8%)
“Possible” pre-diabetesc, # of children (%) 7 (12.3%)
Body Mass Index (BMI), N=69
≥85th-<95th, overweightd, # of children (%) 13 (18.8%)
≥95th, obesityd, # of children (%) 35 (50.7%)
Central adipositye, N=67, # of children (%) 58 (86.6%)
Hypertensionf, N=52, # of children (%) 13 (25.0%)
a. 21 children completed only fitness tes1ng; b. fas7ng blood glucose ≥7.0 mmol/L; c. fas7ng blood glucose 6.1‐6.9 mmol/L; d. CDC percen7le reference for age and gender; e.
NHANESIII: central adiposity = waist circumference ≥85th percen7le for age and gender; f. CDC percen7le reference for age and gender, hypertension: ≥95th percen7le

9. Fitness Tes6ng:
 20m Mul7‐stage Shufle Run beep test (Leger, 1984, 1988)
 Measures maximal oxygen uptake , which indicates aerobic fitness.

10. Baseline fitness percentiles for age and gender, N=90a
Gender (% female) 45.6%
Mean Age (years) 8.0 (range: 4-15 years)
Fitness: percentile for age and genderb, N=67
# of children < 5th percentile (percent) 48 (71.6%)
# of children 5th to <10th percentile (percent) 5 (7.5%)
# of children 10th to <20th percentile (percent) 5 (7.5%)
# of children 20th to <30th percentile (percent) 4 (6.0%)
# of children 30th to <40th percentile (percent) 1 (1.5%)
# of children 40th to < 50th percentile (percent) 3 (4.5%)
# of children 50th to <60th percentile (percent) 1 (1.5%)
# of children below 20th percentilec (percent) 53 (79.1%)
Baseline Fitness results for children who underwent fitness
tes1ng by BRAID‐Kids
a. children under the age of 6 were excluded, per Leger reference (Leger, 1984)
b. (Leger, 1984)
c. rela7ve fitness = >20th percen7le (Downs, 2006)

11. Mean improvements in age‐and‐gender percen1les for children
tested at ~1 year intervals (Leger, 1984), N=19
* p < 0.01 from paired t‐test

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

13. RESULTS AFTER 1 YEAR
We looked at changes for children who had repeat tests
undertaken a;er a ~1 year interval:
 Significant improvements in fitness scores (in age‐and‐gender
percen7le rank and VO2 Max)
No differences 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 Na7ons communi7es.

14. FITNESS ASSESSMENT: INTERPRETATION
Observed improvements in fitness are likely not a direct result of
BRAID‐Kids alone:
 A new physical educa7on program with a specific gym teacher
at the school was very helpful
 Because of regular beep tests in gym class, children became
prac7ced at test procedures
 Increased surveillance communicated a focus on fitness to
children and their families.
 Since many Band Councils control their community’s educa7on
budget and policies, our results may be helpful informa7on for
Leadership decision‐making.

15. FOOD FREQUENCY & PHYSICAL ACTIVITY QUESTIONNAIRE
• BRAID‐Kids u7lized the food frequency and physical ac7vity
ques7onnaire developed and used in the Kahnewake Schools
Diabetes Preven7on Project (KSDPP)
• 91 children completed the ques7onnaire at least once, with
assistance from a parent/guardian
• 29 follow‐up ques7onnaires were completed a;er a ~1 year
interval
Jimenez M, Receveur O, Trifonopoulos M, Kuhnlein H, Paradis G, Macaulay AC. EvaluaAon of dietary change among
children (grades 4–6) from the Kahnawake Schools Diabetes PrevenAon Project. J Am Diet Assoc., 2003;103:1191–1194.

16. PHYSICAL ACTIVYTY
Indicators of Ac1ve/Inac1ve Lifestyle
• Sum of physical ac7vity:
The total number of 15‐minute episodes of 25 sports
and other physical ac7vi7es during and outside of
school hours.
• Frequency of sedentary ac7vi7es:
Television watching and video/internet gaming on
weekdays and on Saturdays.
Sallis J, Strikmiller P, Harsha D, et al. ValidaAon of interviewer and self‐administered physical acAvity checklists for fi?h grade
students. Med Sci Sports Exerc. 1996;28:840–851
Paradis G, Lévesque L, Macaulay AC, et al. Impact of a Diabetes PrevenAon Program on Body Size, Physical AcAvity, and Diet
Among Kanien'kehá:ka (Mohawk) Children 6 to 11 Years Old: 8‐Year Results From the Kahnawake Schools Diabetes PrevenAon
Project. Pediatrics,2005;115:333‐339.

17. Television Viewing and Video Gaming
Values are means (SD).
T‐tests were used to assess differences.
Questionnaire responses by gender (N = 91)
Females (SD) Males (SD) p-value
TV watching on school days 2.6 (1.1) 2.7 (1.3) 0.767
Video/internet gaming on school
days
2.4 (1.0) 2.1 (0.9) 0.224
TV watching Saturday morning 2.6 (0.9) 2.4 (0.9) 0.203
TV watching Saturday afternoon 2.9 (0.8) 2.7 (1.0) 0.285
Video/internet gaming Saturday
morning
3.3 (0.7) 2.8 (1.1) 0.019
Video/internet gaming Saturday
afternoon
3.1 (0.8) 2.7 (1.0) 0.044

18. Television Viewing and Video Gaming
Values are means (SD).
T‐tests were used to assess differences.
Responses to first and second questionnaires (N = 29)
1st Questionnaire
(SD)
2nd Questionnaire
(SD)
p-value
TV watching on school days 2.7 (1.1) 2.5 (1.2) 0.537
Video/internet gaming on school
days
2.2 (1.0) 2.2 (1.0) 0.981
TV watching Saturday morning 2.6 (0.8) 3.1 (0.9) 0.025
TV watching Saturday afternoon 3.0 (0.7) 2.9 (0.8) 0.489
Video/internet gaming Saturday
morning
3.2 (0.8) 3.5 (0.7) 0.199
Video/internet gaming Saturday
afternoon
3.1 (0.9) 3.2 (0.8) 0.621

19. Sum of Physical Ac1vity Frequency
Paradis G, Lévesque L, Macaulay AC, et al. Impact of a Diabetes PrevenAon Program on Body Size, Physical AcAvity, and Diet Among
Kanien'kehá:ka (Mohawk) Children 6 to 11 Years Old: 8‐Year Results From the Kahnawake Schools Diabetes PrevenAon Project. Pediatrics,
2005;115:333‐339.
Values are means (SD).
T‐tests were used to assess differences.
Questionnaire responses by gender (N = 91)
Females (SD) Males (SD) p-value
Total physical activity
in past 7 days
32.0 (17.9) 24.2 (17.7) 0.04
Responses to first and second questionnaires (N = 29 )
1st Questionnaire
(SD)
2nd Questionnaire
(SD)
p-value
Total physical activity
in past 7 days
35.7 (3.8) 21.3 (2.4) <0.001

20. FOOD FREQUENCY
• Nutri7on data were collected by a 7‐day food‐frequency ques7onnaire
adapted from O’Loughlin et al. (2000)
• Ques7ons asked how o;en children ate 51 different foods
• Jimenez et al. (2003) developed three 3‐item subscales of indicators of:
• key high‐sugar food consump7on (so; drink, candy, and
sugared cereal)
• key high‐fat food consump7on (hot dogs, fries, chips)
• fruit and vegetable consump7on (including fruit and
vegetable juices)
O’Loughlin J, Paradis G, Renaud L, Meshefedjian G, Gray‐Donald K. Prevalence and correlates of overweight among elementary
schoolchildren in mulAethnic, low income, inner‐city neighbourhoods in Montreal, Canada. Ann Epidemiol. 2000;8:422–432
Jimenez M, Receveur O, Trifonopoulos M, Kuhnlein H, Paradis G, Macaulay AC. EvaluaAon of dietary change among children (grades 4–
6) from the Kahnawake Schools Diabetes PrevenAon Project. J Am Diet Assoc. 2003;103:1191–1194

21. Key Indicators of Consump1on of High‐sugar Foods,
High‐fat Foods, Fruit and Vegetables
† so; drink, candy, and sweetened cereal
§ hot dogs, fries, chips
‡ includes fruit and vegetable juices
Values are means (SD) scored from 1 (did not eat) to 5 (6 days to everyday).
Paired t‐tests were used to assess differences.
Seven-day food frequency responses by gender (N = 90)
Females (SD) Males (SD) p-value
Key high-sugar food
consumption†
4.0 (1.2) 4.2 (1.4) 0.395
Key high-fat food
consumption§
3.5 (1.3) 3.5 (1.1) 0.967
Fruit and vegetable
consumption‡
4.9 (0.5) 4.9 (0.4) 0.948

22. Key Indicators of Consump1on of High‐sugar Foods,
High‐fat Foods, Fruit and Vegetables
† so; drink, candy, and sweetened cereal
§ hot dogs, fries, chips
‡ includes fruit and vegetable juices
Values are means (SD) scored from 1 (did not eat) to 5 (6 days to everyday).
Paired t‐tests were used to assess differences.
First and second seven-day food frequency responses (N = 27)
1st Questionnaire
(SD)
2nd Questionnaire
(SD)
p-value
Key high-sugar food
consumption†
4.0 (1.2) 4.1 (1.2) 0.780
Key high-fat food
consumption§
3.1 (1.1) 3.4 (1.1) 0.188
Fruit and vegetable
consumption‡
4.9 (0.2) 4.7 (0.6) 0.019

23. IN SUMMARY: KEY FINDINGS
Ager ~1 year interval:
• An increase in the % of children with diastolic (but not systolic)
hypertension.
• Improvement in fitness scores.
• Sum physical ac7vity decreased.
This contradicts the observed improvements in fitness scores.
• Television watching on Saturday mornings increased.
• Fruit and vegetable consump7on decreased.
• No change in high‐sugar and high‐fat food consump7on.

24. POSITIVE COMMUNITY ENGAGEMENT/ACTION
• Some families report having changed their ea7ng habits;
• BRAID‐Kids Project Die77an visi7ng Dri;pile regularly;
• Full‐7me school gym teacher;
• Numerous community efforts at promo7ng preven7on and
healthy living; and,
• CREE PRIDE

25. Drigpile Pow wow

26. Drigpile Cadets

27. Drigpile Youth Baseball

28. Tradi1onal Hand Games

29. Acknowledgements:
Lawson Founda7on
Alberta Center for Child, Family and Community Research
Chief Rose Laboucan
Health Director Florence Willier
Research Assistants:
Trina Scof
Tessirae Sasakamoose
Priscilla Lalonde
U of A support: Kelli Campbell
Die77an: Karie Quinn