Kaat Koort: Examining the impact of a program targeting cardio-metabolic risk and lifestyle changes on heart and brain health among Aboriginal and Torres Strait Islander people

A one-year intervention program will be guided and led by Aboriginal health practitioners (AHPs) and will involve a cardiovascular risk management program, lifestyle program targeting diet and physical activity, targeted advice and coaching for smoking cessation (for current smokers) and depression (for those at high risk of depression). All intervention protocols will be developed in consultation with AHPs and relevant staff from the Aboriginal community-controlled health services. The study will be conducted in two sites in Western Australia (Derbarl Yerrigan Health Service in Perth and South West Aboriginal Medical Service in Bunbury). Please see details of the intervention components below: 1) Cardio-metabolic risk management program: Once the participant’s cardio-metabolic risk factors have been identified, an appointment with the general practitioner (GP) at the health service will be made to form a cardiovascular risk management plan. Pharmacological treatment may be included as part of the care plan if recommended by the GP but it is not a specific component of the intervention. The Aboriginal health practitioner will then meet with the participant to go through the care plan and ensure they have understood the care plan and to answer any questions. There are 15 cardiometabolic risk management visits over 12 months (4 visits in the first 6 weeks then monthly visits). These visits will vary in duration from 30 minutes to 1 hour. 2) Lifestyle Program: Consists of individual and group sessions focused on diet and physical activity. Individual diet sessions: All participant will have an individual appointment with the dietitian during Week 1 to assess their current diet. A tailored diet plan will be created for the participant, based on areas that they are willing to address and per their cardio-metabolic risk factors (e.g. diabetes, high blood pressure). The participant will meet again with the dietitian in Week 2 to assess the diet plan. Starting from month 2 onwards, the individual diet sessions will occur monthly. All individual diet sessions will be 1 hour in duration. Dietary plans will be made in accordance with the Australian dietary guidelines. Adherence to the sessions will be monitored by recording attendance at each session and reasons for not attending. Group diet and physical activity sessions: The first group session focusing on diet and physical activity will start in Month 2 and will occur monthly then after. Groups of 10 participants will meet face-to-face at a suitable venue with a dietitian, exercise therapist and an AHP. The session is expected to last for approximately 2 hours and will cover specific diet topics with infographics that have been specifically designed for this project. The educational topics include: Wholegrains, Dairy, Fast food, Fruits, Vegetables, Healthy fats, Lean meat, Processed/salty foods and Sugar. The group session will also include a physical activity component (approximately 1 hour) where an exercise therapist and AHP will lead a guided physical activity session focusing on aerobic and strength building exercises. Adherence to the sessions will be monitored by recording attendance at each session and reasons for not attending. Group physical activity sessions: In addition to the monthly group diet and physical activity sessions, there will also be monthly sessions focused on physical activity. Groups of 10 participants (preferably the same 10 participants that were in the group diet/physical activity session) will meet face-to-face at a suitable venue with an exercise therapist and AHP who will lead the physical activity session focusing on aerobic and strength building exercises. The exercises will be tailored to the group’s age and abilities and is expected to range from low to vigorous intensity. The session will last for approximately 1 hour. Physical activity recommendations will be made according to the Australian physical activity guidelines. Adherence to the sessions will monitored by recording attendance at each session and reasons for not attending. Participants will also receive a physical activity manual consisting of exercises that can be done at home, which has been specifically developed for this study. The types of exercises included in the group activity will be guided by the exercise therapist and will consist of a range of indoor and outdoor activities, at low, moderate and high intensities. Examples of aerobic (cardio) exercises include: walking, star jumps, group aerobics, dancing, swimming. Examples of strength building exercises include: sit to stand; squats; arm raises; arm curls, air punches, chair dips, sit ups.