Embed Size (px)
Citation preview
Physical activity validation pilot project in Inuit of the Baffin reglon
Daneen Dénommé
School of Dietetics and Human Nutrition McGili University Montreal, Canada
Submitted June 2006
A thesis submitted to McGili University in partial fulfillment of the requirements of the degree of Master of Science in Nutrition
© Daneen Dénommé, 2006
1+1 Library and Archives Canada
Bibliothèque et Archives Canada
Published Heritage Branch
Direction du Patrimoine de l'édition
395 Wellington Street Ottawa ON K1A ON4 Canada
395, rue Wellington Ottawa ON K1A ON4 Canada
NOTICE: The author has granted a nonexclusive license allowing Library and Archives Canada to reproduce, publish, archive, preserve, conserve, communicate to the public by telecommunication or on the Internet, loan, distribute and sell theses worldwide, for commercial or noncommercial purposes, in microform, paper, electronic and/or any other formats.
The author retains copyright ownership and moral rights in this thesis. Neither the thesis nor substantial extracts from it may be printed or otherwise reproduced without the author's permission.
ln compliance with the Canadian Privacy Act some supporting forms may have been removed from this thesis.
While these forms may be included in the document page cou nt, their removal does not represent any loss of content from the thesis.
• •• Canada
AVIS:
Your file Votre référence ISBN: 978-0-494-28478-0 Our file Notre référence ISBN: 978-0-494-28478-0
L'auteur a accordé une licence non exclusive permettant à la Bibliothèque et Archives Canada de reproduire, publier, archiver, sauvegarder, conserver, transmettre au public par télécommunication ou par l'Internet, prêter, distribuer et vendre des thèses partout dans le monde, à des fins commerciales ou autres, sur support microforme, papier, électronique et/ou autres formats.
L'auteur conserve la propriété du droit d'auteur et des droits moraux qui protège cette thèse. Ni la thèse ni des extraits substantiels de celle-ci ne doivent être imprimés ou autrement reproduits sans son autorisation.
Conformément à la loi canadienne sur la protection de la vie privée, quelques formulaires secondaires ont été enlevés de cette thèse.
Bien que ces formulaires aient inclus dans la pagination, il n'y aura aucun contenu manquant.
Abstract
The main goal of this study was to evaluate the utility of physical activity
(PA) measurement in an Inuit population with a self-administered
questionnaire. The objective was to validate a culturally relevant physical
activity questionnaire that measures Inuit PA levels. To do this, the
International Physical Activity Questionnaire (IPAQ) was evaluated against
the Caltrac accelerometer and anthropometrie/physiologie measurements.
There were a number of compliance problems encountered when
implementing the Caltrac in the pilot community which resulted in too few
Caltrac scores available for analyses. However, IPAQ PA score (N=44)
was significantly inversely related to Body Mass Index (P.:::O.05) and
positively related to high-density lipoprotein cholesterol (p.:::O.03).
The results indicate that the IPAQ has potential but needs further
refinements to be acceptable to Inuit populations and needs re-evaluation
in a larger sample. The participants found it very difficult to remember the
time spent performing each activity and, in general, the IPAQ was not weil
received.
i
Résumé
Le but principal de cette étude était de déterminer l'utilité d'un
questionnaire auto-administré pour estimer l'activité physique (AP) des
populations Inuit. L'objectif spécifique était de valider un questionnaire
adapté culturellement pour estimer les niveaux d'AP des Inuit. Ainsi, le
Questionnaire International de l'Activité Physique (IPAQ) a été comparé
avec l'accéléromètre Caltrac et des valeurs anthropométriques et
physiologiques.
Plusieurs problèmes sont survenus lors de l'utilisation du Caltrac dans la
communauté cible. Ceci a eu pour effet de diminuer le nombre de
résultats disponibles pour le Caltrac et d'empêcher l'analyse de ceux-ci.
Cependant, le score AP du IPAQ (N=44) était un déterminant significatif
de l'indice de masse corporelle (p~O.05) et des lipoprotéines de haute
densité (p~O.03).
Selon les résultats obtenus, le IPAQ démontre un certain potentiel mais il
nécessite des améliorations afin d'être mieux adapté aux populations Inuit.
Une réévaluation doit aussi être effectuée avec un plus grand échantillon.
Les participants avaient de la difficulté à déterminer le temps associé à
chacune des activités et en général, le IPAQ n'a pas été bien accepté.
ii
Acknowledgments
Thank you to my supervisors, Dr. Grace Egeland and Dr. Harriet Kuhnlein
for giving me the opportunity to work on this project and for having the
patience to provide guidance throughout the work. 1 feel very privileged to
have spent the last two years at McGili under their supervision. 1 sincerely
feel that the knowledge 1 have gained from this project will be
indispensable in my future endeavours.
1 would like to say a special thank you to my committee member, Mr.
Hugues Plourde. 1 am very grateful for the expertise and insight that he
has brought to this project and 1 especially appreciated his dependability.
This project would not have been possible without the cooperation and
commitment from the Pangirtung Steering Committee who are: Jonah
Kilabuk, Markus Wilcke, Johnny Kuluguqtuq, Donna Kilabuk and our
advisor from Inuit Tapiriit Kanatami, Looee Okalik. Also, 1 would like to
thank our community research assistants: Jojo, Susa, and Emily for
explaining the Caltracs and conducting the interviews. A heartfelt thank
you goes to the committee members and to the study participants for so
graciously accepting us into their community and their personal lives. The
time that 1 spent with them was definitely the highlight of this project.
1 would never have been able to get through this program without the
amazing support of my friends and family. Thank you for ail of the
encouragement, understanding, and most importantly, for ail of the fun
times! 1 am so happy to have shared this experience (and city!) with you.
iii
Table of Contents
Table of Contents ..................................................................................... iv
List of Tables ............................................................................................. vii
List of Figures .......................................................................................... viii
Introduction .............................................................................................. 1
1 Literature Review ................................................................................ 3
1.1 Inuit .............................................................................................. 3
1.1.1 Cultural Transition of Inuit ........................................................ 3
1.1.2 Changes in Aboriginal Peoples' Health .................................... 3
1.2 Overweight and Obesity .............................................................. 4
1.2.1 Health Risks ............................................................................. 4
1.2.2 Quality of Lifel Monetary Costs of Obesity ............................... 4
1.3 Overview of Prevalence of Overweight and Obesity .................... 5
1.3.1 International Trends ................................................................. 6
1.3.2 Canadian Trends ...................................................................... 6
1.4 Determinants of Obesity .............................................................. 7
1.4.1 Role of Physical Activity ........................................................... 7
1.4.2 Role of Diet .............................................................................. 8
1.4.3 Role of Genetics ....................................................................... 8
1.5 Benefits of PA .............................................................................. 9
1.5.1 PA Recommendations ............................................................. 9
1.6 PA Reported in Canada ............................................................. 10
1.7 Why Focus on PA Assessment? ............................................... 10
1.8 Measuring PA ............................................................................ 11
1.8.1 Objective Measures ., ............................................................. 12
1.8.2 Self-Reported Measures ........................................................ 16
1.8.3 Combination Methods ............................................................ 17
1.9 Available Questionnaires ........................................................... 18
1.9.1 The International Physical Activity Questionnaire (lPAQ) ...... 18
1.9.2 The Modifiable Activity Questionnaire (MAQ) ........................ 19
1.9.3 The Canadian Community Health Survey (CCHS) ................. 19
iv
1.10 Cultural Considerations when Measuring PA ............................ 20
1.11 Questionnaire Validation ............................................................ 21
1.11.1 Indirect Indicators of Physical Health and Activity .............. 21
1.11.2 Methods of Validating Questionnaires ................................ 22
2 Community of Focus ......................................................................... 23
3 Specifie Goal and Objective .............................................................. 23
4 Significance of Study ........................................................................ 24
5 Subjects and Methods ...................................................................... 24
5.1 Ethics Approvals and Participatory Processes .......................... 24
5.2 Participant Recruitment ............................................................. 25
5.3 Sample Size .............................................................................. 25
5.4 Component 1: IPAQ Modification .............................................. 26
5.5 Component 2: PA Measurement ............................................... 27
5.6 Data Collection .......................................................................... 27
5.6.1 IPAQ ...................................................................................... 27
5.6.2 Caltrac Activity Monitor .......................................................... 27
5.6.3 Anthropometrie/physiologie reference indicators of PA .......... 28
5.7 IPAQ Data Scoring .................................................................... 28
5.8 IPAQ Data Entry ........................................................................ 29
5.9 IPAQ Data Cleaning .................................................................. 30
5.10 IPAQ PA Continuous Score ....................................................... 30
5.11 IPAQ PA Categorical Score ....................................................... 30
5.12 Canadian Recommendations .................................................... 31
5.13 IPAQ Sitting Question ................................................................ 32
5.14 Caltrac Activity Monitor .............................................................. 32
6 Results .............................................................................................. 34
6.1 Participant Characteristics ......................................................... 34
6.2 Background Analyses ................................................................ 34
6.3 IPAQ PA Analysis ...................................................................... 35
6.4 IPAQ Sitting Question ................................................................ 35
6.5 IPAQ vs. Canadian Recommendations ..................................... 36
v
6.6 Caltrac ....................................................................................... 36
7 Discussion ........................................................................................ 38
8 Conclusion and Summary ................................................................. 42
9 Future Recommendations ................................................................. 43
Bibliography ............................................................................................. 45
Tables ...................................................................................................... 58
Figures ..................................................................................................... 64
APPENDiCES ..... ..................................................................................... 69
Appendix 1: McGili University ethics certificate ..................................... 70
Appendix 2: Nunavut Community-CINE research agreement. ................ 71
Appendix 3: Pangnirtung health screening informed consent forms in
English and Inuktitut. ..... ........................................................................... 72
Appendix 4: Physical activity validation study informed consent forms in
English and Inuktitut. .... ............................................................................ 73
Appendix 5: International Physical Activity Questionnaire (IPAQ) in
English and Inuktitut. ................................................................................ 74
vi
List of Tables
Table 1. Gender and age distribution of participants (N=44) ................ 58
Table 2. Pearson and partial correlation coefficients of IPAQ PA
scores and anthropometrics (N=44) ................................................ 59
Table 3. 8eta coefficients and standard errors (SE) from linear
regressions of IPAQ physical activity scores predicting
anthropometrics .......... , .......... '" ................................................. 60
Table 4. Pearson and partial correlation coefficients of IPAQ Sitting
scores and anthropometrics (N=44) ................................................. 61
Table 5. 8eta coefficients and standard errors (SE) from linear
regressions of IPAQ Sitting scores predicting anthropometrics ............ 62
Table 6. Female and male participants who met Canadian PA
recommendations and those who did not, divided by IPAQ categorical
scores of high, moderate, and low .................................................. 63
vii
List of Figures
Figure 1. Box-plot showing total cholesterol outliers ......................... 64
Figure 2. Box-plot showing triglyceride outliers ................................ 64
Figure 3. Box-plot showing heart rate outliers .................................. 65
Figure 4. Scatter plot of HDL-cholesterol studentized residuals versus
HDL-cholesterol standardized predicted values ................................. 65
Figure 5. Scatter plot of BMI studentized residuals versus BMI
standardized predicted values ....................................................... 66
Figure 6. Scatter plot of ISI studentized residuals versus ISI
standardized predicted values ....................................................... 66
Figure 7. Histogram of HDL-cholesterol studentized residuals ............. 67
Figure 8. Histogram of BMI studentized residuals ............................. 67
Figure 9. Histogram of ISI studentized residuals .............................. 68
viii
1 ntrod uction
Overweight and obesity are significantly associated with many life
threatening chronic diseases which can lead to disability and death.
These diseases include type 2 diabetes, hypertension, high cholesterol
(Kumanyika, Jeffrey, Morabia, Ritenbaugh, & Antipatis, 2002; Mokdad et
aL, 2003; World Health Organization, 2000), stroke, certain (Kumanyika et
aL, 2002; World Health Organization, 2000), arthritis, gastrointestinal
diseases (World Health Organization, 2000), asthma, gallbladder disease,
skin problems, and infertility (Kumanyika et aL, 2002). Beyond the
physical afflictions, psychosocial disorders such as clinical depression and
low self-esteem have been associated with overweight and obesity
(Kumanyika et aL, 2002).
Unbalanced diets and physical inactivity are two of the leading
causes of overweight and obesity (World Health Organization/Food and
Agriculture Organization, 2002). It is thought that by improving dietary
habits and increasing physical activity (PA) patterns, there exists the
potential to reverse the obesity epidemic (Prentice et aL, 2004). Although
these two lifestyle components hold equal importance in determining
health, dietary habits have been more widely studied than PA patterns. It
is thus very important to now make global PA monitoring a priority
(Bauman & Craig, 2005). In order to monitor PA patterns, it is essential to
develop and test the reliability and validity of PA measurement tools.
Canadian leisure-time PA patterns have been monitored frequently
since the 1980's. The Physical Activity Monitor (PAM) (Canadian Fitness
and Lifestyle Research Institute, n.d.) was used to collect data 12 times
between 1981 and 2004 and the Canadian Community Health Survey
(CCHS) (Health Canada, 2005) has been completed twice since 2000.
Until 1998 however, the PAM did not survey the northern territories. There
are limited data available on Inuit PA patterns. There is also a lack of
1
culturally relevant questions used in these two surveys. For example, both
surveys only measured leisure-time PA by providing a list of activities that
included activities such as gardening, rollerblading, and golfing. These
are examples of activities that are infrequently performed in the North due
to environmental conditions. It can be argued that these surveys fail to
capture true PA patterns of Inuit populations due to lack of cultural
relevance.
Given the importance of PA monitoring, a pilot Inuit study was
conducted to help indicate the usefulness of a PA questionnaire.
2
1 Literature Review
1.1 Inuit
Inuit are Aboriginal People of the Canadian Arctic with the majority
of the population living above the 50th parallel. The word "Inuit" means
"the people" in Inuktitut (Natural Resources Canada, 2004). In Nunavut,
the population is 85 percent Inuit (Centre for Research and Information on
Canada, 2002; Natural Resources Canada, 2004). Sixty-two percent of
the Canadian Inuit live in Nunavut and in the Northwest Territories, 21
percent live in Québec, and 10 percent live in Labrador. Nunavut is the
largest territory with an area of 2 million square kilometers, but has the
lowest territorial population; in 2001, Nunavut's 26 communities were
inhabited by 29, 000 people (Government of Nunavut, n.d.). Half of
Nunavut's inhabitants are under the age of 22, which makes the
population the youngest in Canada (Government of Nunavut, n.d.).
1.1.1 Cultural Transition of Inuit
A wide variety of technological advances affected the Inuit's culture
and traditionallifestyle during the 20th century. Before gaining access to
trading companies such as the Hudson's Bay stores, 100 percent of Inuit
diet was derived from traditional food sources. Now, the majority of the
adult Inuit diet consists of market foods with traditional foods contributing
only 10 to 36 percent (Kuhnlein, Receveur, Soueida, & Egeland, 2004).
Also, most hunting and fishing is now carried out using snowmobiles,
outboard motorboats and ali-terrain vehicles (Natural Resources Canada,
2004).
1.1.2 Changes in Aboriginal Peoples' Health
Aboriginal people in Canada suffer from a disproportionate amount
of iIIness compared to other Canadians (MacMillan, MacMillan, Offord, &
3
Dmgle, 1996). They have a higher risk of certain health conditions such
as diabetes, cervical cancer, infectious diseases, suicide, injuries, and
substance abuse (MacMillan et aL, 1996). The Aboriginal people of
Canada have been affected by a rapid dietary transition from traditional
foods to those highly processed and high in fat (Reading, 2003). The
dietary change has been a major factor in the global obesity epidemic
(World Health Organization/Food and Agriculture Organization, 2002) as
weil as the diabetes epidemic among Aboriginal populations (Reading,
2003).
1.2 Overweight and Obesity
1.2.1 Health Risks
Of ail of the diseases and conditions associated with overweight
and obesity, type 2 diabetes mellitus is particularly important as 90 percent
of type 2 diabetics are either overweight or obese (Kumanyika et aL,
2002). The risk of developing other diseases such as stroke,
hypertension, and heart disease also increases with insu lin resistance and
obesity (Kumanyika et al., 2002). While type 2 diabetes has not yet been
seen as a main health concern among Inuit populations (Young, Shrarer,
Shubnikoff, Szathmary, & Nikitin, 1992), a recent study in Greenland
showed a prevalence of newly diagnosed diabetes (Bjerregaard, 2003),
raising concerns in Canada regarding the need for prevention, discussion,
and surveillance.
1.2.2 Quality of Lifel Monetary Costs of Obesity
Obesity is a major contributor to the global burden of disease and
disability (Kumanyika et aL, 2002) and is the most common metabolic
condition in industrialized countries (Birmingham, Muller, Palepu, Spinelli,
& Anis, 1999). The World Health Organization (WHO) has claimed that
obesity should be seen as the main neglected health problem in today's
4
society (World Health Organization, 2000) With this burden, extra
demands are made on health care services and it is reported that the
economic co st of obesity in developed countries such as the United
States, France and Australia ranges from two to six percent of ail health
care costs (Kumanyika et aL, 2002). In 1997, the direct medical co st of
obesity in Canada was 1.8 billion dollars, which represented 2.4 percent of
total health care costs (Birmingham et aL, 1999). From 1990 to 2020, the
global increase of disease burden, measured in Disability Adjusted Life
Years, is expected to increase from 41 percent to 60 percent (Kumanyika
et aL, 2002). In the same 30 year span, deaths due to non-communicable
diseases have been predicted to increase from 28.1 million to 49.7 million
per year and the largest increase in such deaths will be in developing
countries (Kumanyika et aL, 2002). Although under-nutrition and
infectious diseases are still major concems in developing countries,
overweight and obesity are increasing (World Health Assembly 57.17,
2004). There is also an increase in ethnie minorities in developed
countries (World Health Organization, 2001).
1.3 Overview of Prevalence of Overweight and Obesity
Obesity is a complex condition that affects children and adults and
is prevalent in both developed and developing countries (World Health
Organization, 2000). Body mass index (BMI) using Quetelet's index,
which is weight in kilograms over height in squared meters (kg/m2), is the
most common measure of overweight and obesity (Torrance, Hooper, &
Reeder, 2002). The WHO has classified adult overweight as a BMI of 25
or greater and obese as a BMI of 30 or greater (World Health
Organization, 2006). BMI is a simple method of assessment and allows
for between population comparisons (Raine, 2004). BMI does not take
into consideration body composition and should be used with caution
among certain subgroups of the population. These include elderly people,
youth who have not reached their full height potential, and athletes.
5
1.3.1 International Trends
Obesity in industrialized nations has risen dramatically in Canada,
Finland, New Zealand, the United Kingdom, and the United States
between 1989 and 1998 (Raine, 2004). Globally, there are greater than 1
billion overweight adults and 300 million of these obese (World Health
Organization, 2006). In 2001, the Behavioral Risk Factor Surveillance
System (BRFSS) reported that 20.9 percent of adults in the United States
were obese (Mokdad et aL, 2003), which is a large increase, compared to
the results from the 1976-1980 NHANES reporting US adult obesity at
14.5 percent (Flegal, Carroll, Kuczmarski, & Johnson, 1998). When
examining younger populations, it is estimated that, globally, there are
approximately 22 million overweight children under the age of five
(Kumanyika et aL, 2002).
1.3.2 Canadian Trends
1.3.2.1 Adults
National population based surveys have shown an increase in the
prevalence of overweight and obesity among Canadians in the past two
decades (Raine, 2004). Between 1978 and 2004, obesity has increased
from 13.8 percent to 23.1 percent in Canada (Tjepkema & Shields, 2005).
ln 2004, another 36.1 percent were overweight (Tjepkema & Shields,
2005). When combined, these numbers tell us that over half of Canadian
adults do not have a healthy body weight.
1.3.2.2 Aboriginal Groups
ln the late 1980s, the prevalence of Aboriginal men and women of
ail age groups with BMI greater or equal to 26 was higher than other
Canadians (Young & Sevenhuysen, 1989). This difference has not
decreased in the last decade; according to the CCHS (2000-2001), obesity
6
in the northern territories is higher than the national average (Statistics
Canada, 2002). More specifically, the average percentage of obesity in
men and women is 20.2 and 20.4 in Nunavut and 22.4 and 20.4 in the
Northwest Territories, respectively (Statistics Canada, 2005b). It is difficult
to examine overweight and obesity rates in younger Aboriginal populations
as there is very limited anthropometric data of Aboriginal children and
adolescents in Canada (Hanley et aL, 2000).
1.4 Determinants of Obesity
The roles of energy intake and energy expenditure on the
prevalence of overweight and obesity have not been absolutely defined,
but it is evident that an increase in positive energy balance is the major
cause (Bruce & Katzmarzyk, 2002; Flegal et aL, 1998; Katzmarzyk, 2002;
Raine, 2004). The WHO stated: "the fundamental causes of the obesity
epidemic are societal, resulting from an environment that promotes
sedentary lifestyles and the consumption of high-fat, energy-dense diets"
(World Health Organization/Food and Agriculture Organization, 2002).
Unfortunately, the relative contributions of the personal and behavioural
determinants of the Canadian obesity epidemic cannot be fully understood
as there is limited PA and food consumption surveillance data (Raine,
2004).
1.4.1 Role of Physical Activity
A decrease in energy expenditure through decreased physical
activity (PA) is likely one of the chief factors contributing to the obesity
epidemic (World Health Organization/Food and Agriculture Organization,
2002). Physical activity is a protective factor against overweight or obese
(Tremblay & Willms, 2003) and physical inactivity is associated with
increased risks of chronic disease (Pois, Peeters, Kemper, & Grobbee,
1998).
7
1.4.1.1 Occupational and Transportation Activity
Technology developments have allowed for a decrease in energy
expenditure related to occupation and transportation (Kumanyika et aL,
2002; Montoye, 2000). As weil, there has been a decrease in daily labour
needs due to labour-saving technologies (Tremblay & Willms, 2003). Inuit
populations have also been witnessing these changes with ali-terrain
vehicles and snow machines being used as transportation when hunting
and fishing.
1.4.2 Role of Diet
The consumption of high fat, energy-dense diets is one of the major
contributors to the obesity epidemic (Raine, 2004; World Health
Organization/Food and Agriculture Organization, 2002). The global
availability of lower cost oils and fats, and other calorie-dense foods
(Tremblay & Willms, 2003) makes higher fat diets possible even in low
income countries (Kumanyika et aL, 2002). With self-report measures,
there has been some evidence of a decrease in dietary fat intake in some
developed countries such as Canada, although no Aboriginals were
included in this study (Gray-Donald, Jacobs-Starkey, & Johnson-Down,
2000). It has been suggested however that underreporting and not a true
decrease could have been responsible for the decrease from such self
reports (Kumanyika et aL, 2002).
1.4.3 Role of Genetics
It is thought that anywhere from 20 to 75 percent of body
composition and body weight variability within a population may be
attributed to genetics (Hill, Wyatt, & Melanson, 2000). While genetic
factors are important, the obesity epidemic has happened too quickly for
genetics to be the primary cause (Kumanyika et aL, 2002; Tremblay &
Willms, 2003; Vinicor, 2003). However, the gene-environment interaction
8
may have a stronger influence on the emergence of obesity in certain
populations, such as Aboriginal populations (Raine, 2004).
1.5 Benefits of PA
PA can provide a means of improving the general health of the
majority of the population (VVu, Ronis, Pender, & Jwo, 2002). The
mediation of disease risk factors is thought to be part of the protective
effect of PA (Pois et aL, 1998). Cross-sectional studies show that PA is
negatively associated with obesity (Hill et aL, 2000). It has been shown to
be protective against certain diseases, such as certain types of cancer
(Lee & Paffenbarger, 1994), cardiovascular disease (Blair et aL, 1989),
premature death (Brage, Wedderkopp, Franks, Andersen, & Froberg,
2003), and hypertension (Arro Il & Beaglehole, 1992). Also, weight-bearing
exercise, which is assumed to increase bone mass will decrease
osteoporotic fractures (Pois et aL, 1998).
1.5.1 PA Recommendations
ln the Canadian Population Health Initiative (CPHI) 2004 report on
overweight and obesity prevalence, recommendations for eliciting health
benefits from PA is greater than 60 minutes of measured PA per day
(Raine, 2004). For adults who are already performing regular moderate
intensity activities, it is recommended that they also perform vigorous
intensity activity for 20 minutes at least three times per week (Kumanyika
et aL, 2002). The 1995 communication from the U.S. Centers for Disease
Control and Prevention and the American College of Sports Medicine
(Pate et aL, 1995) as weil as the 1996 U.S. Surgeon General's Report
recommended the accumulation of 30 minutes or more of moderate
intensity PA on most days of the week (U.S. Department of Health and
Human Services, 1996). These recommendations were designed to be
used along with previous recommendations of 20 to 60 minutes of
9
moderate to high intensity endurance exercise at least three times weekly
(Pate et aL, 1995). It is thought that the new recommendations will
provide the same health benefits (Hendelman, Miller, Baggett, Debold, &
Freedson, 2000), as weil as allow the public to accumulate the 30 minutes
in separate segments throughout each day (Pate et aL, 1995), which is a
more attainable goal for most people (Hendelman et aL, 2000).
1.6 PA Reported in Canada
The number of Canadians who are physically active in their leisure
time has steadily increased between 1994 and 2003. However, the 1998-
1999 National Population Health Surveys (NPHS) reported that 76.6
percent of women and 73.9 percent of men were insufficiently active
(activity energy expenditure <3.0kcallkg/day) to reap health benefits
(Raine, 2004) and from the CCHS 2003, only 24 percent of Canadians
were reported to be sufficiently active by the same definition (Statistics
Canada,2005b).
1.7 Why Focus on PA Assessment?
It is thought that changes to dietary habits and PA patterns have
the potential to reverse the obesity epidemic (Prentice et al., 2004).
Although these two lifestyle components hold equal importance in
determining health, dietary habits have been more widely studied than PA
patterns. Since physical inactivity is considered to be a current global
health concern (Craig et aL, 2003) and has become a main focus for
public health policy makers (Craig, Russell, & Cameron, 2002). It is thus
very important to prioritize PA monitoring and the development PA
assessment tools to allow for the creation of accurate public health
recommendations.
10
Canadian leisure-time PA patterns have been monitored quite
frequently since the 1980's. The Physical Activity Monitor (PAM) was
used to collect data 12 times between 1981 and 2004 (Canadian Fitness
and Lifestyle Research Institute, n.d.) and the Canadian Community
Health Survey (CCHS) has been completed twice since 2000 (Health
Canada, 2005). Until1998 however, the PAM did not survey the northern
territories. Because of this, there is very limited data available on Inuit PA
patterns. There is a lack of culturally relevant questions used for the two
existing surveys. For example, both surveys only measure leisure-time
PA by providing a list of activities that includes activities such as
gardening, rollerblading, and golfing. These are examples of activities that
are infrequently performed in the North due to environmental conditions. It
can be argued that these surveys fail to capture true PA patterns of Inuit
populations due to a lack of cultural relevance.
1.8 Measuring PA
It is inherently difficult to measure and to quantify daily PA
(Melanson, Freedson, & Freedson, 1996) as it is multidimensional, brief in
duration, (Tremblay, Katzmarzyk, & Wilms, 2002), and has large within
and between person variability (Freedson & Miller, 2000; Terrier, Aminian,
& Schutz, 2001). There are many different methods for assessing PA
patterns and for estimating energy expenditure, but none are considered
to be the 'gold standard' (C. E. Matthews & Freedson, 1995; Pois et aL,
1998). Sorne of these include activity diaries, questionnaires, doubly
labelled water, heart rate monitors, pedometers, and accelerometers. Ali
of these methods have inherent limitations in accuracy and/or feasibility,
but are useful in certain circumstances (Montoye, 2000). Methods to be
used should reflect the objectives of each study, population size, and other
characteristics such as age, gender, and culture (Freedson & Miller, 2000;
Montoye, 2000; Pois et aL, 1998), as weil as cost (Melanson et aL, 1996;
Tremblay et aL, 2002). Until there is an inexpensive, accurate, and simple
11
method for the assessment of PA and energy expenditure, non-ideal
methods are relied upon (Bratteby, Sandhagen, Fan, & Samuelson, 1997).
1.8.1 Objective Measures
Objective measures are the most accu rate methods of estimating
energy expenditure (Staten et aL, 2001). They are limited however to
smaller scale studies due to time requirements and cost (Staten et al.,
2001).
1.8.1.1 Doubly-Labelled Water
Doubly-Iabelled water (DLW) is the most accurate method available
to quantity daily energy expenditure and PA in free-living subjects
(Bratteby et aL, 1997). This method does not restrict or interfere with
habituai physical activities (Bratteby et aL, 1997). DLW is costly and
complicated and is therefore not feasible for large studies (Bratteby et al.,
1997). Also, the DLW method cannot detect short-term changes in PA
and energy expenditure (Bratteby et aL, 1997; Welk, Blair, Wood, Jones, &
Thompson, 2000) and therefore cannot detect patterns in PA (Bassett,
2000) or exercise intensity (Melanson et aL, 1996).
1.8.1.2 Heart Rate Monitors
Heart rate (HR) and energy expenditure are closely related
(Bassett, 2000; Rodriguez et aL, 2002) as HR and oxygen consumption
share a linear relationship at a steady-state of exercise (Bassett, 2000;
Melanson et al., 1996; Trost, 2001). HR monitors can store data to
provide estimates offrequency, intensity, and duration of PA (Trost, 2001).
The use of HR monitoring is restricted by the need to monitor undisturbed
minute-by-minute recording for at least three consecutive days (Bratteby
et aL, 1997). It is also time consuming as individual calibration is needed
12
to determine the relationship between oxygen uptake and HR for each
subject (Bratteby et al., 1997; Trost, 2001).
Because HR takes some time to reflect the intensity of PA being
performed (Trost, 2001; Welk, Corbin, & Kampert, 1998), and is affected
by age, fitness level, and emotions (Bassett, 2000) as weil as mode of
exercise and body size (Trost, 2001), the accuracy of prediction is
questionable. In general, HR monitors have been observed to
overestimate energy expenditure in moderate PA and underestimate time
spent in resting/light activity (Strath, Bassett, Thompson, & Swartz, 2002)
but are found to be useful in selected study populations (Montoye, 2000).
It may not however be appropriate for assessing PA over an extended
period of time as more time is generally spent being inactive than active
on a daily basis (Welk et aL, 1998).
1.8.1.3 Pedometers
Pedometers record vertical acceleration of the body in steps. They
do not measure energy expenditure (Montoye, Kemper, Saris, &
Washburn, 1996) nor do they store data over a specified time interval from
which activity patterns can be seen (Bassett, 2000; Freedson & Miller,
2000). It is thought that pedometers lack sensitivity as they do not
quantify stride length or total body displacement (Levine, Baukol, &
Westerte rp, 2001) and detect fewer than actual steps at slow walking
speeds (Crouter, Schneider, Karabulut, & Bassett, 2003; Le Masurier &
Tudor-Locke, 2003). They cannot distinguish between walking and
running (Bassett, 2000) and are insensitive to cycling and stair c1imbing
(Trost, 2001). The main advantage to using pedometers is that they are
small in size and low in cost (Freedson & Miller, 2000). Pedometers can
be useful in walking intervention studies where a set number of steps are
the goal (Freedson & Miller, 2000). In this way, they can be used as a
motivational tool. The accuracy of the steps recorded varies among
13
different brands of pedometers (Tremblay, Shepard, McKenzie, & Gedhill,
2001) and is influenced by body size and speed of movement (Trost,
2001).
1.8.1.4 Accelerometers
Accelerometers calculate the average amplitude of body
accelerations within a specifie time period (Terrier et aL, 2001) where the
acceleration of the body is directly proportional to the muscular forces
(Montoye et aL, 1996). In theory, accelerometry is the ideal tool for
temporal tracking of the frequency, intensity and duration of physical
activities (Terrier et aL, 2001) as accelerometers provide good estimations
of different PA levels and patterns (Bassett et aL, 2000; Terrier et aL,
2001; Welk et aL, 2000) and can store data for days or weeks at a time
(Hendelman et aL, 2000; Leenders, Sherman, & Nagaraja, 2000).
Accelerometers are available with one, two, or three acceleration
recording planes, with the majority having one or three. The uniaxial
accelerometer was the first, and later the additional planes were added to
capture a greater proportion of free-living activity. However, an
improvement in accuracy depends on the type and therefore direction of
movement performed (Kumahara, Tanaka, & Schutz, 2004) and the
benefits of the additional planes have not been observed unanimously.
Sorne studies have reported similar results for uniaxial and triaxial
accelerometers (Hendelman et aL, 2000; Leenders et aL, 2000; Welk et
aL, 2000; Welk & Corbin, 1995) and sorne have suggested that the triaxial
provides better estimates than the uniaxial models (Bouten, Venne,
Westerterp, Verduin, & Janssen, 1996). It seems that even the more
advanced technologies are subject to the same inherent limitations.
Both uniaxial and triaxial accelerometers have been tested for
accuracy of PA pattern and energy expenditure measurements in
14
controlled environments and in the field at different speeds, intensities,
and during different types of activities. There are many contradictions in
the literature regarding which brand of accelerometers overestimate or
underestimate certain activities. The different methods used to validate
the accelerometer might be to blame for the discrepancies. For example,
when self-reports were used as the validation tool, an underestimation of
energy expenditure was reported (Leenders et al., 2000; C. E. Matthews &
Freedson, 1995); when oxygen consumption was used to validate the
accelerometers, an underestimation of energy expenditure was not
reported by (Sherman et aL, 1998), but was by Kumahara et al. (2004).
Among the conflicting results, there are a few commonalities: the accuracy
of the energy expenditure estimation is higher for walking and running
than for lifestyle activities (Bassett, 2000; Welk et aL, 2000);
accelerometers provide a more accurate measure of PA level and patterns
than prediction of energy expenditure (Bassett, 2000; Leenders et aL,
2000; C. E. Matthews & Freedson, 1995; Welk et aL, 2000); and the
regression equations used by the accelerometers to predict energy
expenditure are not likely to be accu rate for ail types of activities (C. E.
Matthews & Freedson, 1995).
Most accelerometers are designed to be worn on the hip, thus
upper body and upper limb movements are largely underestimated if
detected at ail (Strath et aL, 2002; Swartz et aL, 2000; Welk et aL, 2000).
They are also insensitive to stair climbing and cycling (Trost, 2001). The
extent to which accelerometer outputs are able to reflect changes in
incline have been tested and it was found that the increased energy
expenditure was not recorded in triaxial (Hendelman et aL, 2000; Levine et
aL, 2001) or in uniaxial accelerometers (Hendelman et al., 2000; Nichols,
Morgan, Chabot, Sallis, & Calfas, 2000). Oespite their limitations,
accelerometers are small, non-invasive, and provide objectivity. Do date,
15
they are one of the best methods of PA measurement (Freedson & Miller,
2000; Schutz, Weinsier, Terrier, & Durrer, 2002; Swartz et aL, 2000).
1.8.2 Self-Reported Measures
Self-report measures are simple, inexpensive and appropriate for
large-scale studies (Leenders et aL, 2000) and are the most widely used
methods of measuring PA (Sallis & Saelens, 2000).
1.8.2.1 Activity Diariesl Activity Logbooks
Activity diaries or PA log books have been used for several decades
to measure PA (Bratteby et aL, 1997). They are inexpensive and
uncomplicated to administer and are therefore more suitable than other
methods for population studies (Bratteby et aL, 1997). Activity diaries can
represent a detailed profile of types of PA and the context in which they
were performed (Timperio, Salmon, Rosenberg, & Bull, 2004). The
accuracy of the reported data is highly dependent on the co-operation of
the participants (Bratteby et aL, 1997). It has been found that activity
diaries underestimate energy expenditure during sedentary activity and
overestimate energy expenditure during non-sedentary activities due to
high energy cost equivalents for the latter (Rodriguez et aL, 2002). Short
recording intervals should be used in activity logs because frequent
activities of short duration are habitually underestimated (Bratteby et al.,
1997; Tremblay et aL, 2002).
1.8.2.2 Questionnaires
Questionnaires are usually the most practical method to use in
large-scale epidemiological studies (Masse, 2000; Montoye et aL, 1996;
Pois et al., 1998; Richardson, Ainsworth, Bassett, & Leon, 2001) as they
are inexpensive and feasible (Montoye et aL, 1996) and are non-reactive,
16
meaning they do not elicit behavioural changes of the surveyed
populations (Kriska & Caspersen, 1997). Questionnaires should measure
type, intensity, frequency, and duration of PA (Pois et aL, 1998;
Washburn, Heath, & Jackson, 2000). They should also be simple to
complete, score, and be appropriate for the population in which it is being
used (Richardson et aL, 2001). Some questionnaires are complex and
time consuming to answer; there is limited data suggesting that an
increase in complexity increases questionnaire validity (Tremblay et aL,
2002). If one decides to use a more complex questionnaire, the amount of
assistance available for the respondents during completion should be
considered (Tremblay et aL, 2002). Overestimation is very common with
self-reported PA and this can be addressed by scaling down the
overestimated records (Tremblay et aL, 2001). Published tables of energy
costs of various activities are needed to convert data obtained from
questionnaires into estimated energy expenditure.
1.8.3 Combination Methods
Each method, whether subjective or objective has many limitations.
Many researchers have combined different methods in an attempt to
compensate for these limitations. HR monitors and accelerometers have
been used simultaneously to increase the accuracy of energy expenditure
prediction of lifestyle activities (Freedson & Miller, 2000; Swartz et aL,
2000; Welk et aL, 1998). Strath et al. (2002) found an increase in energy
expenditure accuracy but the combined technique has limited application
due to its time consuming nature. Welk et al. (1998) found that the
combined methods provided no great advantage over the HR and
accelerometer alone. Different combinations of accelerometer placements
have also been used on individual subjects. In an attempt to record upper
limb movement, accelerometers have been placed on wrists as weil as
hips (Swartz et aL, 2000). It was found that the improvement in accuracy
of prediction was not justified by the additional cost, data analysis, and
17
required time (Kumahara et al., 2004; Swartz et al., 2000). Self-report
methods such as PA log books can be used in combination with certain
objective measures to capture the physical activities that are overlooked
by these objective measures.
1.9 Available Questionnaires
The PA questionnaires that are being used by different government
and non-government organizations in various countries vary significantly.
Frequently, the components of the questionnaires that differ are the time
frame, complexity, type of activity surveyed, and scoring protocol (type,
duration, frequency, and intensity) (Kriska & Caspersen, 1997). Other
differences are whether the questionnaire is self or interview administered.
It is also important to note that not ail questionnaires being used have
been tested for validity and reliability.
1.9.1 The International Physical Activity Questionnaire (IPAQ)
The International Physical Activity Questionnaire (IPAQ) was
developed in 1996 by an International Consensus Group in an attempt to
address the lack of internationally comparable PA measures (IPAQ, 2005).
Two versions of the IPAQ were developed, the short and long versions.
The short version was designed to be used in surveillance studies. The
long version was designed for a more comprehensive assessment of daily
PA and to be used in research. The IPAQ assesses PA performed in
different domains including leisure time, domestic activities, work-related,
and transport-related activity and is designed to be culturally adaptable.
The reliability and validity tests of the IPAQ show that its abilities to
measure PA are comparable to other generally accepted self-report PA
methods. Correlation ranges of 0.34 to 0.89 in reliability studies and 0.14
to 0.53 in validation studies were seen (Craig et al., 2003).
18
The IPAQ has been selected for use in various high profile studies
such as the European Physical Activity Surveillance System (EUPASS),
the European Health Interview Survey (EUROHIS), the Countrywide
Integrated Non-communicable Oisease Intervention (CINOI), and the
WHO World Health Survey (WHS) (IPAQ, 2005). However, the statistical
methods used to determine the reliability and validity of the IPAQ have
been criticized (Hallal & Victoro, 2004) and a study involving the
measurement of PA of urban indigenous Australians abandoned the IPAQ
when the participants had considerable problems understanding and
completing the questionnaire (Marshall, 2004).
1.9.2 The Modifiable Activity Questionnaire (MAQ)
The Modifiable Activity Questionnaire (MAQ) is designed to be
adaptable to many different populations. Past-year and past-week
occupational and leisure activities are assessed as weil as inactivity
caused by disability. It is recommended that the questionnaire be
administered via trained interviewer of the sa me race or ethnic group as
the respondents (Kriska, 2000). The MAQ was formerly known as the
Pima Indian Physical Activity Questionnaire and thus its reliability and
validity have been tested in Pima Indian men and women of various ages
(Kriska et aL, 1990).
1.9.3 The Canadian Community Health Survey (CCHS)
The Canadian Community Health Survey (CCHS) is a government
funded cross-sectional survey that collects data on health status, health
care use, and health determinants such as PA for the Canadian population
(Statistics Canada, 2005a). The CCHS is interview-administered and
focuses primarily on leisure-time PA with a time frame of the previous
three months.
19
1.10 Cultural Considerations when Measuring PA
There are four general tasks that survey responders must perform:
interpretation, memory retrieval, judgment formation, and response editing
(Warnecke et al., 1997). When developing or choosing a questionnaire to
use, it is important to bear in mind the notions of emic and etic constructs:
emic constructs have culturally specifie meanings whereas etic constructs
are considered to be universally understood. Using standardized
questions to elicit information from a multicultural society may elicit a
category fallacy, that is, when emic constructs are treated as etic
constructs (Warnecke et aL, 1997).
Variability of responses might be affected by the meanings different
cultures and subgroups, age and gender for example, attach to certain
concepts (Mayer et aL, 1991). It has been suggested that providing eues
in the questions that will enhance the respondents' understandings will
help to address this problem of misinterpretation (Warnecke et aL, 1997),
and having an administrator of the sa me race or ethnicity conduct the
interviews is very important (Marshall, 2004). Also, questions must be
very specifie and unambiguous to the ethnie and cultural group being
measured (Kriska, 2000). Open-ended questions should be used with
caution as they are prone to interpretation biases (Kriska, 2000). Patterns
of response editing meant to enhance social desirability regarding health
and risk behaviour were also found to be related race and ethnicity
(Warnecke et aL, 1997). Many questionnaires solely focus on leisure-time
or recreational PA but when the study population has a large intra
variation of occupational activity, these questionnaires would not be
appropriate (Wareham et aL, 2002). Also, the assessment of multiple
domains of PA and not only leisure-time PA is needed for an
internationally comparable PA measure (Craig et aL, 2003).
20
1.11 Questionnaire Validation
1.11.1 Indirect Indicators of Physical Health and Activity
There are some anthropometric and physiologic parameters that
have been shown to be affected by PA and to reflect physical health. HR
has been related to ali-cause mortality and is considered a predictor of
physical health status (Seccareccia et aL, 2001). It has also been seen in
epidemiological studies (R H Fagard, 2005) and in meta-analyses of
randomized-controlled trials (Robert H Fagard, 2001; Whelton, Chin, Xin,
& He, 2002) that blood pressure decreases with an increase in PA. BMI
was used as an indirect physiologic measure of long term PA as BMI
should be inversely proportional to average energy expenditure (Littman et
al.,2004).
It has been seen that sedentary lifestyles are associated with a gain
of abdominal fat (Slentz et aL, 2005) and that aerobic exercise has been
shown to reduce intra-abdominal fat (Okura, Nakata, Lee, Oh kawa ra , &
Tanaka, 2005). Waist-hip circumference ratio gives a representation of
both subcutaneous and intra-abdominal adipose tissue (Gibson, 1990)
which, when measured with BMI improves the prediction of the health
burden of obesity (World Health Organization, 2000). Bioelectrical
impedance is a safe and convenient way of determining body composition
in terms of fat-free mass (Gibson, 1990).
Basal metabolic rate (BMR) can also be used as an indirect PA
reference indicator as there is a positive relationship between the two; PA
increases basal metabolism (Whitney & Rolfes, 2002).
Insulin resistance, which elicits clinical abnormalities such as
elevated glucose (Fletcher & Lamendola, 2004), is directly related to an
individual's level of PA (Seals et aL, 1984), and according to Hawley et al.
(2004), regular PA is an effective method of improving insulin action where
21
insu lin resistance is present. It has been found that insu lin sensitivity can
be improved by participating in regular exercise programs of moderate and
vigorous intensities (Houmard et aL, 2004). Seals et al. (1984) have also
found that a decrease in insulin sensitivity seen with increasing age can
sometimes be prevented by participating in regular vigorous PA (Seals et
al., 1984). The homeostasis model assessment (HOMA) is a common
measure of insu lin resistance (O. R. Matthews et aL, 1985). The
Quantitative Insulin Sensitivity Check Index (QUICKI) (Katz et aL, 2000)
and the Insu lin Sensitivity Index (IS10,120) (Gutt et aL, 2000) are weil
established measures of insu lin sensitivity.
It has been seen that PA has a positive effect on blood lipid profiles
(W. Haskell, 1986). In two different meta-analysis of randomized
controlled trials, total cholesterol and triglycerides were lowered and high
density lipoprotein cholesterol was increased in participants enrolled in
aerobic exercise programs (Halbert, Silagy, Finucane, Withers, &
Hamdorf, 1999; Kelley, Kelley, & Tran, 2005).
Although the literature presents strong evidence the there are in
fact relationships between PA and health outcomes such as those
mentioned above, less is known about the particular nature of these
relationships. Currently, there are only definitive dose-response
relationships between PA and rates of certain diseases such as coronary
heart disease and type 2 diabetes (Kesaniemi et aL, 2001). The dose
response relationships between su ch health outcomes as blood pressure,
blood lipids, and obesity have yet to be determined (Kesaniemi et al.,
2001).
1.11.2 Methods of Validating Questionnaires
One of the main limitations of PA questionnaire validation studies is
that there is no universally accepted 'gold standard' to act as validity
22
instrument for questionnaires and surveys (Pois et aL, 1998; Timperio et
aL, 2004; Washburn et aL, 2000). Doubly-Iabelled water is considered
one of the best references for validating questionnaires, but only reflects
average energy expenditure over a short period of time (Montoye et aL,
1996), is expensive, time consuming, cannot distinguish between different
activities (Stel et aL, 2004) and is problematic to execute in remote
communities. Accelerometers (Tremblay et aL, 2002) and HR monitors
(Bassett, 2000) can similarly be used to validate questionnaires as they
can measure intensity, frequency, and duration as weil as energy
expenditure. Self-report methods such as logbooks and activity diaries
are other practical methods of validating PA questionnaires (Timperio et
aL, 2004).
2 Community of Focus
The current study was conducted in the community of Pangnirtung
on Baffin Island in the Canadian territory of Nunavut. The majority of the
people are Inuit with a total community population of 1200. The most
frequent language spoken is Inuktitut. Fisheries and local artists are major
contributors to the community's economy. This community was chosen in
response to the community's request for an investigation into rising obesity
and type 2 diabetes mellitus rates.
3 Specifie Goal and Objective
The main goal of this study was to evaluate the utility of PA
measurement of Inuit populations with interview-administered
questionnaires. The objective was to assess criterion validity between the
interview-administered International Physical Activity Questionnaire
(lPAQ) and the Caltrac™ accelerometer (Hemokinetics) as weil as assess
the predictive validity of the IPAQ on indirect physiologic and
anthropometric indicators of physical activity.
23
4 Significance of Study
The validation of a culturally relevant PA questionnaire for Inuit
populations is important for the two main reasons. First, it is necessary to
have valid data on Inuit PA patterns that can be compared to other
national and international values, and second, it will allow for the
evaluation of public intervention programs.
5 Subjects and Methods
The aim of this study was to validate the International Physical
Activity Questionnaire (IPAQ) with the Caltrac™ accelerometer
(Hemokinetics) and with indicators of physical fitness.
5.1 Ethics Approvals and Participatory Processes
Approvals from the McGill Ethics Review Committee, the Nunavut
Research Institute, and the community were obtained (Appendix 1). The
Hamlet was involved in the development of a Community-Centre for
Indigenous People's Nutrition and Environment (CINE) research
agreement (Appendix 2) which used the participatory process developed
by the WHO and Dr. Harriet Kuhnlein from CINE (World Health
Organization and Centre for Indigenous Peoples' Nutrition and
Environment, 2003). This participatory process attempts to "balance
interests, benefits and responsibilities between the Indigenous Peoples
(IP) and the research institution (RI) concerned, through a commitment to
equitable research partnership ... the entire process, from planning to
reporting, will be transparent and accessible to ail parties involved" (World
Health Organization and Centre for Indigenous Peoples' Nutrition and
Environment, 2003). Guidance and feedback was provided by the Inuit
Tapiriit Kanatami (ITK), the Government of Nunavut Health and Social
Services Department and the Nunavut Tunngavik Incoporated. Inuktitut
translations of the consent forms (Appendices 3 and 4) and IPAQ
24
(Appendix 5) were done by the members of the community steering
committee and the community research assistants. The interviews were
performed by bilingual Inuktitut community researcher assistants.
5.2 Participant Recruitment
This PA pilot project was one part of a larger community health
screening pilot project involving Inuit adults aged 18 years and over.
Three information sessions held by the community research assistants as
weil as pamphlets and radio announcements were used as recruitment
tools. Participants who volunteered for the larger health screening were
also informed about the PA validation study. Interested participants were
given a separate consent form explaining the purpose and goals of the
study, the role of the participants and researchers, the potential risks to
the participants, and the benefits that would be gained by the participants
fram the research being conducted. A signed consent form was obtained
fram each participant before the study began. Ali data were collected
during a one and a half week period in May of 2005.
5.3 Sam pie Size
The sample size of this study was determined by two main criteria:
the sample sizes used in previous PA questionnaire validation studies and
the number of available participants in the community. Previous validation
studies have reported a wide range of study participants. On the lower
end, a sample size of 35 was reported by Staten et al. (2001) for the
validation of the Arizona Activity Frequency Questionnaire, while on the
higher end, (Stel et aL, 2004) used 439 participants for the validation of
the Longitudinal Aging Study Amsterdam (LASA) Physical Activity
Questionnaire. The majority of validation studies however, have used an
intermediate sample size. For example, there were 26 population samples
taken fram twelve countries in the IPAQ validation study, and the median
25
sample size was 90 (Craig et aL, 2003) and 89 participants were used for
the validation of the Sub-Saharan Africa Activity Questionnaire (Sobngwi,
Mbanya, Unwin, & Aspray, 2001). Our projected sample size was
approximately 50-60 male and female participants, but due to time and
costs constraints, we had 56 participants in total, 30 of whom wore the
Caltrac. Of these 56 participants, 12 were not included in the analysis as
they did not complete the IPAQ which left a sample size of 44. Of the 30
Caltrac participants, equipment failure and compliance problems resulted
in only 18 participants successfully completing the Caltrac monitoring for
seven days.
5.4 Component 1: IPAQ Modification
The interview-administered, short-version of the IPAQ was used in
this study. The IPAQ assesses PA performed in different domains
including leisure time, domestic activities, work-related, and transport
related activity over the last seven days. The short version of the IPAO
includes information on the time spent walking, in vigorous and moderate
intensity activities, and in sedentary activity. It is recommended that
cultural adaptations are made to the physical activities used in the original
IPAQ questionnaire in order to increase cultural relevance (IPAQ, 2005).
The IPAQ protocol emphasizes three key concepts related to cultural
adaptation. These include conceptual equivalence, which ensures that
people atlach the same meaning to terms and concepts used; metric
equivalence, which ensures the substitute activities have the same
intensity levels as the original activities; and linguistic equivalence, which
ensures that the meanings rather than words of the questions are
translated appropriately. Nunavut Health Promotion Specialists,
Community Health Representatives, and members of the local community
were consulted during the cultural adaptation of the IPAO in this study.
These people worked together to decide on a list of culturally appropriate
26
examples of physical activities to replace the original examples in the
IPAQ.
5.5 Component 2: PA Measurement
PA was measured with the IPAQ and a Caltrac activity monitor,
which is an electronic monitor that uses an accelerometer to detect
movement. The participant's basal metabolic rate is calculated by the
Caltrac by imputing age, weight, height, and gender. This monitor is worn
at hip level and is attached on the outer surface of the clothes. It is small
(about the size of a pager) and non-invasive. This type of monitor is
considered one of the best methods of PA measurement (Freedson &
Miller, 2000; Schutz et aL, 2002; Swartz et aL, 2000). The Caltrac was
used successfully in previous questionnaire validation studies (Richardson
et aL, 2001; Sobngwi et aL, 2001).
5.6 Data Collection
5.6.1 IPAQ
Each participant was asked to complete one IPAQ when they
returned the Caltrac. The IPAQ examined PA of the previous seven days,
which was the same seven days recorded by the Caltrac.
5.6.2 Caltrac Activity Monitor
Each participant was asked to wear a Caltrac activity monitor for
seven consecutive days. During the orientation period before the study
began, each participant was given explicit instructions in English and
Inuktitut on how to operate the Caltrac and was informed of the
precautions that should be taken when wearing the Caltrac. The
precautions included the types of activities that should not be performed
while wearing the Caltrac such as bathing and swimming, and how to
27
properly attach the monitor to clothing. The participants were given
contact information where they were able to reach a member of our
research team if difficulties arose with the Caltrac. Also, when the
participants came to the clinic to answer other questionnaires or to have
measurements taken, they were asked if they were having any difficulties
with the Caltrac and if they were, appropriate steps were taken to solve
the problems.
5.6.3 Anthropometrie/physiologie referenee indieators of PA
Based on the available anthropometric measurements obtained
from the participants during the Pangnirtung Health Screening pilot project
as weil as drawing on the current literature, heart rate (HR), systolic blood
pressure (SBP) and diastolic blood pressure (DBP), body mass index
(BMI), waist circumference ryvC), total cholesterol (T-chol), high-density
lipoprotein cholesterol (HDL-chol), triglycerides (TG), homeostasis model
assessment of insu lin resistance (HOMA), Insulin Sensitivity Index (ISI),
and Quantitative Insulin Sensitivity Check Index (QUICKI) were used in
these analyses.
5.7 IPAQ Data Seoring
The data collected from each IPAQ provided separate scores on
walking; moderate and vigorous intensity activities, and sitting. The
overall level of activity is represented as a combined total score of walking
and the moderate and vigorous intensity activities. Metabolic equivalents
(METs), which are multiples of resting metabolic rate at a standard body
weight of 60 kilograms and were used to measure the volume of each type
of activity, which yielded a MET-minutes score. The MET-mins used in
the IPAQ are from the 2000 compendium of PA which lists MET scores
associated with over 600 activities (Ainsworth et aL, 2000).
28
The IPAO was scored as both categorical and continuous scores.
The categorical scores are: low, moderate, and high and are based on
specifie criteria set by the IPAO International Consensus Group (IPAO,
2005). The low level represents the lowest level of PA and those who fall
in this category are considered 'insufficiently active'. Individuals at the
moderate level are classified as 'sufficiently active'. The individuals
meeting the requirements for the high level exceed the current pubic
health guidelines for PA in the United States and are said to be
accumulating enough activity to provide health benefits (lPAO, 2005).
5.8 IPAQ Data Entry
The IPAO scores for the Baffin community were first entered into
Windows Excel. For the vigorous, moderate, and walking questions, time
was converted from hours and minutes to minutes, and then subsequently
into MET-minutes/week.
MET values and formula for computation of MET-mins from the IPAO
protocol (IPAO, 2005) were followed and were:
Walking MET -minutes/week = 3.3*walking minutes*walking days
Moderate MET -minutes/week = 4.0*moderate-intensity activity
minutes*moderate days
Vigorous MET-minutes/week = 8.0*vigorous-intensity activity
minutes*vigorous days
The MET values used in this computation were derived trom the
IPAO Reliability Study (Craig et aL, 2003). The IPAO protocol does not
instruct that the sitting question be included in the summary score of PA
but rather separately evaluated as median values and interquartile ranges.
29
5.9 IPAQ Data Cleaning
Missing Values
If respondents refused to answer or responded 'don't know' for
either the day or time variables, or if data were missing in either walking,
moderate, or vigorous days or minutes, that case was removed from the
analysis. One participant was excluded due to missing values.
Truncation of data
Following the IPAO protocol's recommendation, ail walking,
moderate, and vigorous time variables exceeding '180 minutes/week' were
truncated to be equal to '180 minutes/week' and added as a new variable
(IPAO,2005). This truncation allows for a maximum of 21 hours of activity
in each PA category to be reported in one week.
5.10 IPAQ PA Continuous Score
Two continuous scores of PA were used. One variable was the
IPAO PA MET-mins which is the metabolic equivalent of the seven day
sum of vigorous and moderate intensity activity as weil as walking. The
second score was the IPAO PA kcals which represents the seven day sum
of the calorie expenditure from vigorous and moderate intensity activity as
weil as walking obtained from the following equation: MET-min x (weight in
kilograms/60 kilograms) (IPAO, 2005). The most important difference
between these two scores is that individual body weight is a factor in the
IPAO PA kcals and is not included in the IPAO PA MET-mins.
5.11 IPAQ PA Categorical Score
The criteria used to place the participants into the low, moderate,
and high categories were as follows:
30
high:
a) Vigorous-intensity activity on at least three days and
accumulating at least 1500 MET-minutes/week OR
b) seven or more days of any combination ofwalking, moderate
intensity or vigorous intensity activities achieving a minimum of at
least 3000 MET -minutes/week.
moderate:
a) Three or more days of vigorous activity of at least 20 minutes per
dayOR
b) five or more days of moderate-intensity activity or walking of at
least 30 minutes per day OR
c) five or more days of any combination of walking, moderate
intensity or vigorous intensity activities achieving a minimum of at
least 600 MET -min/week.
low:
a) If respondents do not meet the criteria for the other two groups.
5.12 Canadian Recommendations
ln the Canadian Population Health Initiative 2004 report on
overweight and obesity prevalence, the recommendation for eliciting
health benefits from PA is to perform greater than 60 minutes of measured
PA per day (Raine, 2004). In this study, the participants were said to meet
these Canadian recommendations if their IPAQ met one of the following
criteria:
31
1. Seven or more days of walking, moderate-intensity or vigorous intensity
activity for at least 60 minutes.
2. Seven or more days of any combination of walking, moderate-intensity
or vigorous intensity activities achieving a minimum of 60 minutes/day. It
is noted that while the combined number of days may add up to seven, the
IPAO does not provide information on the days of the week, thus it is
unknown whether the different activities were actually performed on seven
different days.
5.13 IPAQ Sitting Question
As previously stated, the IPAO has one question on time spent
sitting. The IPAO sitting question is not included in the summary score of
PA. Two sitting variables were produced: IPAO Sitting kcals and IPAO
Sitting MET -mins. Sitting has a MET score of one, therefore the Sitting
MET -min/week score is equal to the number of sitting minutes multiplied
by seven days.
The IPAO Sitting kcals was then obtained using the same equation
that was used to calculate the IPAO PA kcals which is: MET-min x (weight
in kilograms/60 kilograms) (IPAO, 2005).
5.14 Caltrac Activity Monitor
The Caltrac scores of energy expenditure estimates of PA were in
kilocalories. Two separate scores were recorded from the Caltracs:
1. The number of total kilocalories used (CALS USED). This number
includes ail energy expenditure, including when the participants
were in motion and when they were sedentary (sleep). This is
possible as the Caltrac continues to record energy expenditure
32
representing the participant's basal metabolism when the
participant is not performing any PA. Since the scores were
recorded by the research team when the Caltracs were returned,
this score would continue to accumulate until the Caltrac was
returned.
2. The number of kilocalories expended during PA or motion (CALS
USED ACTM). This number is solely recorded during movement.
ln order for the participants to have been deemed compliant, they
had to have worn the Caltrac for at least five of the seven days. When the
participants returned the Caltracs, they were asked how many days they
were compliant. Knowing the number of days that the Caltrac had been
worn, and having the two separate Caltrac scores of energy expenditure,
we were able to adjust each participant's total score of energy expenditure
to represent an average of seven days.
For example, if the participant had worn the Caltrac for only six
days, then the CALS USED score was simply divided by six and then
multiplied by 7. However, because the participants were not able to stop
the Caltracs trom recording, the adjustment became more complicated if
the participant had only worn the Caltrac for six days but had kept it for
eight days. Here the activity kcals would be subtracted from the total kcals
in order to get a basal kcals score. Then a seven day basal kcals score
would be found from eight days and a seven day activity kcals score would
be found from six days. The seven days basal and activity scores would
then be added together to get the total seven day kcals score. In this
example, the seven day total kcals score would have been the only
Caltrac score used that participant.
33
6 Results
6.1 Participant Characteristics
There were a total of 44 participants, 12 male and 32 female (Table
1). The age ranged from 19 to 74 with a mean age of 45. The mean
IPAQ score was 2099 kcals/day and the median was 2067 kcals/day. The
mean BMI was 28.2 which falls in the overweight category (World Health
Organization, 2006), but 20 out of the 44 participants were obese, 16 were
overweight, and eight were normal weight. The mean systolic blood
pressure was 110 mm Hg and the mean diastolic blood pressure was 73
mm Hg. Regarding the participants' blood lipid profiles, the mean values
for T -chol, HLD-chol, and TG were 4.12 mmol/L, 1.15 mmol/L, and 1.07
mmol/L respectively.
6.2 Background Analyses
Ali of the dependent variables were tested for outliers in SPSS
using the 'Explore' function. Of those tested, T-chol, TG, and HR (Figures
1-3) were found to have outliers. Ali tables presented are based on
analyses without outliers. The analyses were performed with and without
the outliers. The linear regression model assumptions which are that the
residuals are normally distributed, have a constant variance, and are
independent were checked with scatter plots of the standardized residuals
versus the predicted values (Figure 4-6) and with histograms of the
studentized residuals (Figure 7-9) (Stevens, 2002). With small sample
sizes however, nonnormality is sometimes difficult to see graphically due
to sample error (Stevens, 2002), thus the Kolmogorov-Smirnov test was
also performed on the dependent variables. From this test, only the
QUICKI variable was seen to deviate from normality. Both the IPAQ PA
kcals and IPAQ PA MET-mins had similar positively skewed distributions.
34
Bivariate correlations between the dependent variables show that
their relationships correspond with what is seen in the literature. For
example, WC was positively correlated with BMI (psO.01) while HDL-chol
was negatively correlated with BMI (psO.05). Also, it is normal to see
lower energy expenditure in females than males and to see a decrease in
energy expenditure with age. In this study, there were negative but not
significant correlations with both IPAO PA kcals and IPAO PA MET-mins
and age, and male participants had higher mean PA energy expenditure
than the females (1032 vs. 838 kcals/day).
6.3 IPAQ PA Analysis
There were no significant bivariate correlations between the two
IPAO PA scores and any of the dependent variables (Table 2). Two sets
of linear regressions were performed for each dependent variable.
Because we had 44 participants in total, we adjusted for three dependent
variables in the first set of regressions (age, gender, and waist
circumference) when evaluating the primary dependent variable of
interest. In the second set of analyses, men were excluded which left 32
participants and analyses adjusted for age and waist circumference. Both
IPAO PA kcals (psO.05) and IPAO PA MET-mins (psO.05) variables were
significantly inversely related to BMI when men were excluded and the
regression model was adjusted for age and waist circumference (Table 3).
Also, the IPAO PA MET-mins was a significant predictor (psO.05) and
IPAO PA kcals was a borderline significant predictor (p=0.06) of HDL-chol
when the men were excluded in analyses adjusting for age and waist
circumference (Table 3).
6.4 IPAQ Sitting Question
The median sitting energy expenditure was 2552 calories/week.
The interquartile range was 2325 calories/week. There was a significant
35
inverse correlation between the IPAO Sitting kcals and HOL-chol (r = -
0.37, p.:s.0.01) and positive correlations between the IPAO Sitting kcals and
SMI (r = 0.43, p.:s.0.01), and WC (r = 0.44, p.:s.0.01) (Table 4). However,
partial correlations between IPAO Sitting kcals and the anthropometric
measures while controlling for body weight were not significant (Table 4).
Also, IPAO Sitting kcals was not a significant predictor of any dependent
variable in the multivariable linear regressions (Table 5).
6.5 IPAQ vs. Canadian Recommendations
Thirty-one out of the 44 participants met the Canadian
recommendations for PA (Table 6). Ali of the 24 participants in the high
active group and seven of the moderate active participants made up the
group who met the Canadian recommendations. None of the participants
who were placed in the low category met the Canadian recommendations.
Five out of the 12 participants who were labelled as moderately active by
IPAO standards, did not meet the requirements to be considered
sufficiently active by Canadian standards.
6.6 Caltrac
There were a number of problems implementing the Caltrac in the
community, which resulted in too few Caltrac scores available for
analyses. Thirty Caltracs were given out in total, but only 18 participants
successfully completed the trial and 15 of the 18 were women.
Although the study population showed great interest in wearing the
Caltracs, many compliance problems arose during the study. These
problems were less attributed to the participants' willingness to adhere to
the requirements, and more to functional factors associated with the
design of the Caltrac and to the physical environment. Attempts were
36
made throughout the study to rectify the problems, but most could not be
corrected.
Twice, the pin used to attach the clip to the rest of the Caltrac was
jiggled loose, separating the clip from the Caltrac, which caused the
Caltrac to fall off the participants. This happened while shovelling snow
and playing volleyball. Two other participants said that the clip was too
loose which caused the Caltrac to repeatedly fall off when walking. These
participants reported that when the Caltrac would hit the floor, the
numbers would reset. There were a few incidents where participants
removed the batteries at night when they took off the Caltracs. After these
incidents, a piece of tape was placed over the batteries before the
Caltracs were handed out. Also, because of the cold temperatures, one
participant's batteries died within three days of wearing the Caltrac.
Sorne participants wore the Caltrac for fewer than the required
seven days and sorne kept the Caltrac for longer than the seven days.
This usually happened when the participants left town during the seven
day monitoring period; they either returned the Caltrac before they left
which would mean they were monitored for fewer than seven days, or kept
the Caltrac until they returned to the community which meant it was
recording data for longer th an seven days. The study team also noticed
that many of the participants wore pants with elastic waistbands which
made it difficult to keep the Caltracs in proper position on the body. Two
participants were seen wearing their Caltracs in the front pockets of their
pants which does not allow for proper PA recording.
37
7 Discussion
Over 75 percent of the participants were either obese or
overweight. The IPAQ PA kcals and MET-mins were able to predict BMI
and HDL-chol in multivariate regressions but were not significantly
correlated with any other anthropometric or physiologic measures.
Although the literature is inconclusive, there is evidence to suggest
that the effect of PA on blood lipids is dependent on the intensity of
activity. In one meta-analysis of randomized controlled trials, it was
reported that T -chol was affected more by higher intensity exercise
programs and TG and HDL-chol were more affected by lower intensity
exercise programs (Halbert et aL, 1999). There are currently no concrete
dose-response data available for exercise and blood lipids, but a
'threshold' may exist before changes in lipids occur (Halbert et aL, 1999).
It is unclear if this 'threshold' is related to volume of exercise or baseline
lipid concentrations 0fV. L. Haskell, 1986) as it appears that nonstructured
lifestyle activities do not affect blood lipids (Leon & Sanchez, 2001) and
that the higher the lipid concentrations prior to exercise programs the
greater the reduction (W. L. Haskell, 1986). To address the issue of
exercise volume, linear regressions were performed for T-chol, HDL-chol,
and TG once again, but this time the IPAQ outcome variable was the
caloric energy expenditure of vigorous activity only in both kcals and MET
mins. No significant relationships were found with vigorous activity and
the blood lipids, but this is not entirely surprising considering that only 12
participants performed vigorous activity in the community pilot study.
There are currently no available data on thresholds that can be
used with which to compare the IPAQ Sitting scores (IPAO, 2005). The
IPAQ Sitting kcals score was significantly correlated with BMI, HDL-chol,
and WC. These relationships are consistent with the evidence that
physical inactivity has a negative impact on health status. It is interesting
38
to note that the IPAO Sitting kcals score has stronger correlations with
SMI and HDL-chol than the IPAO PA kcals score. One reason for this
trend may be that it could be easier to recall time spent sitting than it is to
remember time spent in different physical activities. In this way, sitting,
which is an inverse proxy of PA, may be a useful indicator of health risks.
As previously stated, the important difference between the MET
mins and kcals scores in both IPAO PA and IPAO Sitting is that body
weight is a factor when kcals are calculated but not a factor in the formula
used to calculate MET-mins. The fact that the IPAO Sitting MET-mins
score was not correlated with any of the dependent variables suggests
that it is the effect of body weight and not the actual energy expenditure of
sitting that is producing the results seen with the IPAO Sitting kcals score.
Furthermore, there were no significant partial correlations between the
IPAO Sitting kcals score and HDL-chol and SMI when controlling for body
weight.
It is clear that the two extreme IPAO categorical scores, high and
low, parallel the criteria used to determine if the Canadian
recommendations have been met as none of the participants who were
placed in the low category and ail of those in the high active group met the
Canadian recommendations. There is sorne disagreement with the
moderately active group; by IPAO standards, moderately active is
sufficiently active, but in this study, five out of the 12 participants who were
labelled as moderately active by IPAO standards did not meet the
requirements to be considered sufficiently active by Canadian standards.
Overreporting of PA has been seen with the IPAO in the past
(Rzewnicki, Auweele, & Sourdeauhuij, 2003) and the means and medians
of reported PA by the IPAO have been higher than public health
recommendations in sorne European countries (Rutten et aL, 2003). One
39
argument for this observation is that the IPAQ incorporates a wide range
of activity domains whereas many other questionnaires focus only on
leisure-time PA (Rzewnicki et aL, 2003). This pattern is seen in the
current study as, according to the IPAQ scores, over 70 percent of the
participants met the Canadian recommendation for PA which is an
accumulation of at least 60 minutes of measured activity per day. This is
much different than what was reported by the CCHS 2003 which was that
only 24 percent of Canadians met this sa me level of activity but only
measured leisure-time PA (Statistics Canada, 2005b).
Originally, as suggested by the IPAQ International Committee, we
had planned to use the IPAQ long version as it was designed for a more
comprehensive assessment of daily PA and suitable for use in health
research (IPAQ, 2005). When the Nunavut Health Promotion Specialists,
Community Health Representatives, and Community Steering Committee
were consulted, it was unanimous that the long version would be too
demanding on the participants to complete and suggested that the short
version be used. Using the short version was a compromise in regards to
the amount of detail we were able to obtain from the IPAQ, but if the long
version would have been used, it is likely that fewer participants would
have agreed to complete the questionnaire.
The feedback from the interviewers was that many of the
participants found it very difficult to recall the specifie number of days and
length of time they had spent being physically active. This was reflected in
the data as many of the participants reported inconceivably high levels of
activity. Very similar to what Rzewnicki et al. (2003) reported, the bilingual
Inuktitut community research assistants also had difficulty explaining to the
participants the differences between the intensities of PA. Specifically,
differentiating between what activities were to be considered 'moderate
intensity activities' and those that were to be recorded as 'walking'. This
40
was due to the many 'moderate-intensity' activities that are performed
while walking, such as carrying light loads and children, thus, there was
overlap between these two categories. One of the interviewers suggested
that to avoid confusion, the order of the IPAO items should be re-arranged
so that the 'walking' question would be first.
This study is limited due to the low number of participants and the
homogeneity of the sample: 73 percent were women and 43 percent of the
participants were 50 years and older.
The study results show that the IPAO has potential. However, it
needs further refinements to be acceptable to Inuit and needs re
evaluation in a larger sample.
41
8 Conclusion and Summary
When this project was being developed, the Caltrac was intended
to be used as the primary IPAO validation tool. However, with sa many
Caltrac technical mishaps, the data set was tao small to evaluate the
validity of the IPAO against an objective measurement of activity. Similar
technical difficulties with the Caltrac were observed in a questionnaire
validation study in the Pi ma Indians (Kriska et aL, 1990). Secause the
Caltracs did not perform as anticipated, the focus was placed on the
participants' anthropometric and physiologic measurements which are
known to correlate with physical activity as a means of validating the
IPAO. From these analyses, it was found that the IPAO PA kcals and
MET-mins scores were significant predictors of HDL-chol and SMI in
multivariate regression analyses. The IPAO Sitting kcals score was
significantly correlated with HDL-chol and SMI. The results from the IPAO
Sitting kcals score must be interpreted with caution, however, as the
evidence points to body weight, and not energy expenditure of sitting, as
the true predictor of HDL-chol, SMI, and WC.
42
9 Future Recommendations
If there would have been enough Caltrac scores to analyze, it would
have been very useful to have an output score from the Caltrac that was
not obtained by using body weight. In the future, choosing an objective
PA measure that produces energy expenditure scores as both calories
and a score such as number of steps or distance traveled should be
considered. This would have been useful as body weight heavily
influences how many calories the Caltrac reports for each participant.
Choosing an accelerometer or pedometer that is more sturdy and hearty
than the Caltrac would also be advised. There were many problems with
pieces of the Caltrac breaking and the Caltrac itself falling off of the
participants. Also, it might be of interest to choose a monitor that has a
case or cover which makes it more difficult for the participants to change
the settings and remove the batteries.
ln regards to the IPAQ, we did not spend enough time training the
interviewers on how to ask the questions properly and to answer the
participants' questions in the most appropriate ways. We assumed that
administering the questionnaire was simpler than it actually was for
participants. From the feedback from the interviewers, it was obvious that
there were serious misconceptions and misunderstandings of the
definitions of the different PA intensities. When training the interviewers,
we should have spent more time on the interpretations of these definitions.
ln the future, proper and thorough interview training and immediate follow
up with participants would likely increase the accuracy of the responses as
weil as lessen the participant burden caused by the misunderstanding and
frustration that is attached to retroactive recall.
Future work should assess whether time spent sitting is a useful
indicator of health risks. In this study, participants had an easier time
43
remembering how long they had spent sitting each day than remembering
different intensities of daily PA.
44
Bibliography
Ainsworth, B. E., Haskell, W. L., Whitt, M. C., Irwin, M. L., Swartz, A. M.,
Strath, S. J., et al. (2000). Compendium of physical activities: an
update of activity codes and met intensities. Medicine and Science
in Sports and Exercise, 32(9), S498-S516.
Arro Il , B., & Beaglehole, R (1992). Ooes physical activity lower blood
pressure: a critical review of the clinical trials. Journal of Clinical
Epidemiology, 45(5),439-447.
Bassett, O. R, Jr. (2000). Validity and reliability issues in objective
monitoring of physical activity. Research Quarterly for Exercise and
Sport, 71(2), 30-36.
Bassett, O. R, Jr., Ainsworth, B. E., Swartz, A M., Strath, S. J., O'Brien,
W. L., & King, G. A (2000). Validity of four motion sensors in
measuring moderate intensity physical activity. Medicine and
Science in Sports and Exercise, 32(9), S471-S480.
Bauman, A, & Craig, C. L. (2005). The place of physical activity in the
WHO Global Strategy on diet and physical activity. International
Journal of 8ehavioral Nutrition and Physical Activity, 10(2), 1-6.
Birmingham, C. L., Muller, J. L., Palepu, A, Spinelli, J. J., & Anis, A H.
(1999). The cost of obesity in Canada. Canadian Medical
Association Journal, 160(4),483-488.
Bjerregaard, P. (2003). Contribution of population surveys to the study of
cardiovascular disease and diabetes in Greenland. International
Journal of Circumpolar Health, 62(4),331-342.
Blair, S. N., Kohl, H. W. 1., Paffenbarger, R S., Clark, D. G., Cooper, K. H.,
& Gibbons, L. W. (1989). Physical fitness and ali-cause mortality: a
prospective study of healthy men and women. The Journal of the
American Medical Association, 262(17),2395-2401.
Bouten, C. V., Venne, W. P. V.-V. d., Westerte rp, K. R, Verduin, M., &
Janssen, J. O. (1996). Daily physical activity assessment:
45
comparison between movement registration and doubly labelled
water. Journal of Applied Physiology, 81(2), 1019-1026.
Brage, S., Wedderkopp, N., Franks, P. W., Andersen, L. B., & Froberg, K.
(2003). Reexamination of validity and reliability of CSA monitor in
walking and running. Medicine and Science in Sports and Exercise,
35(8), 1447-1454.
Bratteby, L.-E., Sandhagen, B., Fan, H., & Samuelson, G. (1997). A 7-day
activity diary for assessment of daily energy expenditure validated
by the doubly labelled water method in adolescents. European
Journal of Clinical Nutrition, 51(9), 585-591.
Bruce, M. J., & Katzmarzyk, P. T. (2002). Canadian populations trends in
leisure-time physical activity levels, 1981-1998. Canadian Society
for Exercise Physiology, 27(6),681-690.
Canadian Fitness and Lifestyle Research Institute. (n.d.). Physical Activity
in Canada. Retrieved January 30,2006, from
http://www.cflri.ca/cflri/pa/index.html
Centre for Research and Information on Canada. (2002). The Canadian
North: Embracing Change, The CRIC Papers (pp. 1-36).
Craig, C. L., Marshall, A. L., Sjostrom, M., Bauman, A. E., Booth, M. L.,
Ainsworth, B. E., et al. (2003). International Physical Activity
Questionnaire: 12-country reliability and validity. Medicine and
Science in Sports and Exercise, 35(8),1381-1395.
Craig, C. L., Russell, S. J., & Cameron, C. (2002). Reliability and validity of
Canada's Physical Activity Monitor for assessing trends. Medicine
and Science in Sports and Exercise, 34(9), 1462-1467.
Crouter, S. E., Schneider, P. L., Karabulut, M., & Bassett, D. R., Jr. (2003).
Validity of 10 electronic pedometers for measuring steps, distance,
and energy cost. Medicine and Science in Sports and Exercise,
35(8), 1455-1460.
46
Fagard, R. H. (2001). Exercise characteristics and the blood pressure
response to dynamic physical training. Medicine and Science in
Sports and Exercise, 33(Suppl. 6), S484-S492.
Fagard, R. H. (2005). Effects of exercise, diet and their combination on
blood pressure. Journal of Human Hypertension, 19(5uppl. 3), S20-
S24.
Flegal, K. M., Carroll, M. D., Kuczmarski, R. J., & Johnson, C. L. (1998).
Overweight and obesity in the United States: prevalence and
trends, 1960-1994.lnternationaljournalofObesity, 22(1), 39-47.
Fletcher, B., & Lamendola, C. (2004). Insulin Resistance Syndrome.
Journal of Cardiovascular Nursing, 19(5),339-345.
Freedson, P. S., & Miller, K. (2000). Objective monitoring of physical
activity using motion sensors and heart rate. Research Quarterly for
Exercise and Sport, 71(2),21-29.
Gibson, R. S. (1990). Principles of nutritional assessment. New York, New
York: Oxford University Press.
Government of Nunavut. (n.d.). Our Land. Retrieved March 14,2006, from
http://www.gov.nu.ca/NunavutlEnglish/aboutlourland.pdf
Gray-Donald, K., Jacobs-Starkey, L., & Johnson-Down, L. (2000). Food
habits of Canadians: reduction in fat intake over a generation.
Canadian Journal of Public Health, 91(5),381-385.
Gutt, M., Davis, C. L., Spitzer, S. B., Llabre, M. M., Kumar, M., Czarnecki,
E. M., et al. (2000). Validation of insulin sensitivity index (ISI0.120):
comparison with other measures. Diabetes Research and Clinical
Practice, 47(3), 177-184.
Halbert, J. A, Silagy, C. A, Finucane, P., Withers, R. T., & Hamdorf, P. A
(1999). Exercise training and blood lipids in hyperlipidemic and
normolipidemic adults: a meta-analysis of randomized, controlled
trials. European Journal of Clinical Nutrition, 53(7), 514-522.
47
Hallal, P. C., & Victoro, C. G. (2004). Reliability and validity of the
International Physical Activity Questionnaire (IPAQ). Medicine and
Science in Sports and Exercise, 36(3), 556.
Hanley, A. J., Harris, S. B., Gittelsohn, J., Wolever, T. M. S., Saksvig, B.,
& Zinman, B. (2000). Overweight among children and adolescents
in a Native Canadian community. American Journal of Clinical
Nutrition, 71(3),693-700.
Haskell, W. (1986). The influence of exercise training on plasma lipids and
lipoproteins in health and disease. Acta medica Scandinavica,
711(711 SuppL), S25-S37.
Haskell, W. L. (1986). The influence of exercise training on plasma lipids
and lipoproteins in health and disease. Acta medica Scandinavica,
711(SuppL 711), S25-S37.
Health Canada. (2005). Canadian Community Health Survey. Retrieved
January 30, 2006, from http://www.hc-sc.gc.ca/fn
an/surveili/nutrition/commun/index e.html
Hendelman, D., Miller, K., Baggett, C., Debold, E, & Freedson, P. (2000).
Validity of accelerometry for the assessment of moderate intensity
physical activity in the field. Medicine and Science in Sports and
Exercise, 32(SuppL 9), S442-S449.
Hill, J. O., Wyatt, H. R., & Melanson, E L. (2000). Genetic and
environmental contributions to obesity. Medical Clinics of North
America, 84(2),333-346.
Houmard, J. A., Tanner, C. J., Sientz, C. A., Duscha, B. D., McCartney, J.
S., & Kraus, W. E (2004). Effect of the volume and intensity of
exercise training on insulin sensitivity. Journal of Applied
Physiology, 96(1), 101-106.
IPAQ. (2005). International Physical Activity Questionnaire. Retrieved
February 1, 2005, from
http://www.ipaq.ki.se/IPAQ.asp?mnu sel=BBA&pg sel=JJA
48
Katz, A, Nambi, S. S., Mather, K., Baron, AD., Follmann, D. A, Sullivan,
G., et al. (2000). Quantitative Insulin Sensitivity Check Index: a
simple, accu rate method for assessing insulin sensitivity in humans.
The Journal of Clinical Endocrinology and Metabolism, 85(7), 2402-
2410.
Katzmarzyk, P. T. (2002). The Canadian obesity epidemic, 1985-1998.
Canadian Medical Association Journal, 166(8), 1039-1040.
Kelley, G. A, Kelley, K. S., & Tran, Z. V. (2005). Exercise, lipids, and
lipoproteins in older adults: a meta-analysis. Preventive Cardiology,
8(4), 206-214.
Kesaniemi, Y. A, Elliot Danforth, J., Jensen, M. D., Kopelman, P. G.,
Lefebvre, P., & Reeder, B. A (2001). Dose-response issues
concerning physical activity and health: an evidence-based
symposium. Medicine and Science in Sports and Exercise,
33(Suppl. 6), S351-S358.
Kriska, A. M. (2000). Ethnie and cultural issues in assessing physical
activity. Research Quarterly for Exercise and Sport, 71(2),47-53.
Kriska, A. M., & Caspersen, C. J. (1997). Introduction to a collection of
physical activity questionnaires. In: a collection of physical activity
questionnaires for health-related research. Medicine and Science in
Sports and Exercise, 29(Suppl. 6), S73-S78.
Kriska, A. M., Knowler, W. C., LaPorte, R E., Drash, A L., Wing, R R,
Blair, S. N., et al. (1990). Development of questionnaire ta examine
relationship of physical activity and diabetes in Pi ma Indians.
Diabetes Care, 13(4), 401-411.
Kuhnlein, H. V., Receveur, O., Soueida, R, & Egeland, G. M. (2004). Artic
Indigenous Peoples experience the Nutrition Transition with
changing dietary patterns and obesity. The Journal of Nutrition,
134(6), 1447-1453.
Kumahara, H., Tanaka, H., & Schutz, Y. (2004). Daily physical activity
assessment: what is the importance of upper limb movements vs.
49
whole body movements? International Journal of Obesity, 28(9),
1105-1110.
Kumanyika, S., Jeffrey, R, Morabia, A, Ritenbaugh, C., & Antipatis, V. J.
(2002). Obesity prevention: the case for action. International
Journal of Obesity, 26(3), 425-436.
Le Masurier, G. C., & Tudor-Locke, C. (2003). Comparison of pedometer
and accelerometer accuracy under controlled conditions. Medicine
and Science in Sports and Exercise, 35(5),867-871.
Lee, 1. M., & Paffenbarger, R S., Jr. (1994). Physical activity and its
relation to cancer risk: a prospectve study of college alumni.
Medicine and Science in Sports and Exercise, 29(7),831-837.
Leenders, N., Sherman, W. M., & Nagaraja, H. N. (2000). Comparisons of
four methods of estimating physical activity in adult women.
Medicine and Science in Sports and Exercise, 32(7), 1320-1326.
Leon, A S., & Sanchez, O. A (2001). Response of blood lipids to exercise
training alone or combined with dietary intervention. Medicine and
Science in Sports and Exercise, 33(Suppl. 6), S501-S515.
Levine, J. A, Baukol, P. A, & Westerterp, K. R (2001). Validation of the
tracmor triaxial accelerometer system for walking. Medicine and
Science in Sports and Exercise, 33(9), 1593-1597.
Littman, A J., White, E., Kristal, A R, Patterson, R E., Satia-Abouta, J.,
& Potter, J. D. (2004). Assessment of a one-page questionnaire on
long-term recreational physical activity. Epidemiology, 15( 1), 105-
113.
MacMillan, H. L., MacMillan, A 8., Offord, D. R, & Dingle, J. L. (1996).
Aboriginal health. Canadian Medical Association Journal, 155(11),
1569-1578.
Marshall, A L. (2004). Measuring physical activity in urban indigenous
australians: final report 2004. Brisbane: The University of
Queensland.
50
Masse, L. C. (2000). Reliability, validity, and methodological issues in
assessing physical activity in a cross-cultural setting. Research
Quarterly for Exercise and Sport, 71(2),54-58.
Matthews, C. E., & Freedson, P. S. (1995). Field trial of a three
dimensional activity monitor: comparison with self report. Medicine
and Science in Sports and Exercise, 27(7), 1071-1078.
Matthews, D. R, Hosker, J. P., Rudenski, A S., Naylor, B. A, Treacher,
D. F., & Turner, R C. (1985). Homeostasis model assessment:
insu lin resistance and (!-cell function from fasting glucose and
insulin concentrations in man. Diabetologia, 28(7),412-419.
Mayer, E. J., Alderman, B. W., Regensteiner, J. G., Marshall, J. A,
Haskell, W. L., Baxter, J., et al. (1991). Physical activity
assessment measures compared in a biethnic rural population: the
san Luis Valley Diabetes study. American Journal of Clinical
Nutrition, 53(4), 812-820.
Melanson, E. L., Jr., Freedson, M. S., & Freedson, P. (1996). Physical
activity assessments: a review of methods. Critical Reviews in Food
Science and Nutrition, 36(5), 385-396.
Mokdad, A H., Ford, E. S., Bowman, B. A, Dietz, W. H., Vinicor, F.,
Baies, V. S., et al. (2003). Prevalence of obesity, diabetes, and
obesity-related health risk factors, 2001. The Journal of the
American Medical Association, 289(1), 76-79.
Montoye, H. J. (2000). Introduction: evaluation of some measurements of
physical activity and energy expenditure. Medicine and Science in
Sports and Exercise, 32(Suppl. 9), S439-S441.
Montoye, H. J., Kemper, H. C. G., Saris, W., & Washburn, RA (1996).
Measuring physical activity and energy expenditure. Champaign, IL:
Human Kinetics Publishers.
Natural Resources Canada. (2004). People & Society: Nunavut. Retrieved
November 6, 2005, from
http://atlas.gc.ca/site/english/maps/peopleandsociety/nunavut/1
51
Nichols, J. F., Morgan, C. G., Chabot, L. E., Sallis, J. F., & Calfas, K. J.
(2000). Assessment pf physical activity with the Computer Science
and Applications, Inc., accelerometer: laboratory versus field
validation. Research Quarterly for Exercise and Sport, 71(1),36-43.
Okura, T., Nakata, Y., Lee, D. J., Ohkawara, K., & Tanaka, K. (2005).
Effects of aerobic exercise and obesity phenotype on abdominal fat
reduction in response to weight loss. International Journal of
Obesity, 29(10), 1259-1266.
Pate, R R, Pratt, M., Blair, S., Haskell, W. L., Macera, C. A., Bouchard,
C., et al. (1995). Physical activity and public health. A
recommendation from the Centers for Disease Control and
Prevention and the American College of Sports and Medicine. The
Journal of the American Medical Association, 273(5),402-407.
Pois, M. A., Peeters, P. H. M., Kemper, H. C. G., & Grobbee, D. E. (1998).
Methodological aspects of physical activity assessment in
epidemiological studies. European Journal of Clinical Nutrition,
14(1),63-70.
Prentice, R L., Willett, W. C., Greenwald, P., Alberts, D., Bernstein, L.,
Boyd, N. R, et al. (2004). Nutrition and physical activity and chronic
disease prevention: research strategies and recommendations.
Journal of the National Cancer Institute, 96(17), 1276-1287.
Raine, K. D. (2004). Overweight and Obesity in Canada: A Population
Health Perspective. Ottawa: Canadian Institute for Health
Information.
Reading, J. (2003). A global model and national network for aboriginal
health research excellence. Canadian Journal of Public Health,
94(3), 185-189.
Richardson, M. T., Ainsworth, B. E., Bassett, D. R, Jr., & Leon, A. S.
(2001). Validation of the Standford 7 -day Recall to assess habituai
physical activity. Annals of Epidemiology, 11(2), 145-153.
52
Rodriguez, G., Beghin, L., Michaud, L., Moreno, L. A, Turck, D., &
Gottrand, F. (2002). Comparison of the Tritrac-R3D accelerometer
and a self report activity diary with heart-rate monitoring for the
assessment of energy expenditure in children. British Journal of
Nutrition, 87(6), 623-631.
Rutten, A, Ziemainz, H., Schena, F., Stahl, T., Stiggelbout, M., Auweele,
Y. V., et al. (2003). Using different physical activity measurements
in eight European countries. Results of the European Physical
Activity Surveillance System (EUPASS) time series survey. Public
Health Nutrition, 6(4), 371-376.
Rzewnicki, R, Auweele, Y. V., & Bourdeauhuij, 1. D. (2003). Addressing
overreporting on the International Physical Activity Questionnaire
(IPAQ) telephone survey with a population sample. Public Health
Nutrition, 6(3),299-305.
Sallis, J., & Saelens, B. E. (2000). Assessment of physical activity by self
report: status, limitations, and future directions. Research Quarterly
for Exercise and Sport, 71(2), 1-14.
Schutz, Y., Weinsier, S., Terrier, P., & Durrer, D. (2002). A new
accelerometric method to assess the daily walking practice.
International Journal of Obesity, 26(1), 111-118.
Seals, D. R, Hagberg, J. M., Allen, W. K., Hurley, B. F., Dalsky, G. P.,
Ehsani, A A, et al. (1984). Glucose tolerance in young and older
athletes and sedentary men. Applied Physiology, 56(6), 1521-1525.
Seccareccia, F., Pannozzo, F., Dima, F., Minoprio, A, Menditto, A, Noce,
C. L., et al. (2001). Heart rate as a predictor of mortality: the
MATISS project. American Journal of Public Health, 19(8), 1258-
1263.
Sherman, W. M., Morris, D. M., Kirby, T. E., PEtosa, R A, Smith, B., Frid,
D. J., et al. (1998). Evaluation of a commercial accelerometer
(Tritrac-R3D) to measure energy expenditure during ambulation.
International Journal of Sports Medicine, 19(1),43-47.
53
Sientz, C. A, Aiken, L. B., Houmard, J. A, Baies, C. W., Johnson, J. L.,
Tanner, C. J., et al. (2005). Inactivity, exercise, and visceral fat.
STRRIDE: a randomized, controlled study of exercise intensity and
amount. Journal of Applied Physiology, 99(4), 1613-1618.
Sobngwi, E., Mbanya, J. C. N., Unwin, N. C., & Aspray, T. J. (2001).
Development and validation of a questionnaire for the assessment
of physical activity in epidemiology studies in Sub-Saharan Africa.
International Journal of Epidemiology, 30(6), 1361-1368.
Staten, L. K., Taren, D. L., Howel, W. H., Tobar, M., Poehlman, E. T., Hill,
A, et al. (2001). Validation of the Arizona Activity Frequency
Questionnaire using doubly labeled water. Medicine and Science in
Sports and Exercise, 33(11),1959-1967.
Statistics Canada. (2002). "Canadian Community Health Survey" A first
Look, The Dai/y. Retrieved November 14, 2004, from
http://www.statcan.ca/english/concepts/health/
Statistics Canada. (2005a). Detai/ed information for 2005 (Cycle 3.1).
Retrieved January 12, 2006, from http://www.statcan.ca/cgi
bin/imdb/p2SV.pl?Function=getSurvey&SDDS=3226&db=IMDB&1a
ng=en&dis=2&adm=8#b2
Statistics Canada. (2005b). Health Indicators. Retrieved November 3,
2005, from http://www.statcan.ca/english/freepub/82-221-
XI E/2004002/nonmed/behaviours3. htm#leisure
Stel, V. S., Smit, J. H., Pluijim, S. M. F., Visser, M., Deeg, D. J. H., & Lips,
P. (2004). Comparison of the LASA physical activity questionnaire
with a 7 -day diary and pedometer. Journal of Clinical Epidemiology,
57(3), 252-258.
Stevens, J. P. (2002). Applied mutivariate statistics for the social sciences
(Fourth ed.). Mahwah, New Jersey: Lawrence Erlbaum Associates,
Ine.
Strath, S. J., Bassett, D. R., Jr., Thompson, D. L., & Swartz, A M. (2002).
Validity of the simultaneous heart rate motion sensor technique for
54
measuring energy expenditure. Medicine and Science in Sports and
Exercise, 34(5), 888-894.
Swartz, A. M., Strath, S. J., Bassett, O. R., Jr., O'Brien, W. L., King, G. A.,
& Ainsworth, B. E. (2000). Estimation of energy expenditure using
CSA accelerometers at hip and wrist sites. Medicine and Science in
Sports and Exercise, 32(Suppl. 9), S450-S456.
Terrier, P., Aminian, O., & Schutz, Y. (2001). Can accelerometry
accurately predict the energy cost of uphill/downhili walking?
Ergonomies, 44( 1), 48-62.
Timperio, A., Salmon, J., Rosenberg, M., & Bull, F. C. (2004). Do logbooks
influence recall of physical activity validation studies? Medicine and
Science in Sports and Exercise, 36(7),1181-1186.
Tjepkema, M., & Shields, M. (2005). Measured Obesity: Adult obesity in
Canada (No. Catalogue no. 82-620-XWE2005001). Ottawa:
Statistics Canada.
Torrance, G. M., Hooper, M. O., & Reeder, B. A. (2002). Trends in
overweight and obesity among adults in Canada (1970-1992):
evidence from national surveys using measured height and weight.
International Journal of Obesity, 26(6), 797-804.
Tremblay, M. S., Katzmarzyk, P. T., & Wilms, J. O. (2002). Temporal
trends in overweight and obesity in Canada, 1981-1996.
International Journal of Obesity, 26(4),538-543.
Tremblay, M. S., Shepard, R. J., McKenzie, T. L., & Gedhill, N. (2001).
Physical activity assessment options within the context of the
Canadian physical activity, fitness, and lifestyle appraisal. Canadian
Society for Exercise Physiology, 26(4),338-407.
Tremblay, M. S., & Willms, J. o. (2003). Is the Canadian childhood obesity
epidemic related to physical inactivity. International Journal of
Obesity, 27(9), 1100-1105.
55
Trost, S. G. (2001). Objective measurement of physical activity in youth:
current issues, future directions. Exercise and Sport Sciences
Re vie ws, 29(1), 32-36.
U.S. Department of Health and Human Services. (1996). Physical Activity
and Health: A Report of the Surgeon General: U.S. Department of
Health and Human Services, Centers for Disease Control and
Prevention, National Center for Chronic Disease Prevention and
Health Promotion.
Vinicor, F. (2003). Diabetes, obesity, and the politics of health: What are
the real causes of this epidemic? What is its impact? What will it
take to turn the tide? Ethnicity & disease, 13(3), S28-S29.
Wareham, N. J., Jakes, R. W., Rennie, K. L., Mitchell, J., Hennings, S., &
Day, N. E. (2002). Validity and repeatability of the Epic-Norfold
physical activity questionnaire. International Journal of
Epidemiology, 31(1), 168-174.
Warnecke, R. 8., Johnson, T. P., Chavez, N., Sudman, S., Q'Rourke, D.
P., Lacey, L., et al. (1997). Improving question wording in surveys
of culturally diverse populations. Annals of Epidemiology, 7(5),334-
342.
Washburn, R. A., Heath, G. W., & Jackson, A. W. (2000). Reliability and
validity issues concerning large-scale surveillance of physical
activity. Research Quarterly for Exercise and Sport, 71(2),104-113.
Welk, G. J., Blair, S. N., Wood, K., Jones, S., & Thompson, R. W. (2000).
A comparative evaluation of three accelerometry-based physical
activity monitors. Medicine and Science in Sports and Exercise,
32(9), S489-S497.
Welk, G. J., & Corbin, C. B. (1995). The valdity of the Tritrac-R3D activity
monitor for the assessment of physical activity in children.
Research Quarterly for Exercise and Sport, 66(3),202-209.
Welk, G. J., Corbin, C. 8., & Kampert, J. 8. (1998). The validity of the
Tritrac-R3D activity monitor for the assessment of physical activity:
56
Il. temporal relationships among objective assessments. Research
Quarterly for Exercise and Sport, 69(4),395-399.
Whelton, S. P., Chin, A., Xin, X., & He, J. (2002). Effect of aerobic
exercise on blood pressure: a meta-analysis of randomized,
contralled trials. Annals of InternaI Medicine, 136(7),493-503.
Whitney, E. N., & Rolfes, S. R. (2002). Understanding Nutrition. In (9th
ed., pp. 284). Belmont, CA: Wadsworth.
World Health Assembly 57.17. (2004). Global strategy on diet and physical
activity. Geneva: World Health Organization.
World Health Organization. (2000). Obesity: preventing and managing the
global epidemic - Report of a WHO Consultation on Obesity.
Geneva: WHO.
World Health Organization. (2006). Obesity and Overweight. Retrieved
November 7,2005, fram
http://www.who.intldietphysicalactivity/publications/facts/obesity/enl
World Health Organization and Centre for Indigenous Peoples' Nutrition
and Environment. (2003). Indigenous peoples and participatory
health research. Geneva: WHO.
World Health Organization/Food and Agriculture Organization. (2002).
Diet, Nutrition and the Prevention of Chronic Disease: Report of a
joint WHO/FAO Expert Consultation (No. 916).
Wu, T.-Y., Ronis, D. L., Pender, N., & Jwo, J.-I. (2002). Development of
questionnaires to measure physical activity cognitions among
Taiwanese adolescents. Preventive Medicine, 35(1), 54-64.
Young, T. K., & Sevenhuysen, G. (1989). Obesity in northern Canadian
Indians: patterns, determinants, and consequences. American
Journa/ of Clinica/ Nutrition, 49(5), 786-793.
Young, T. K., Shrarer, C. D., Shubnikoff, E. V., Szathmary, E. J., & Nikitin,
Y. P. (1992). Prevalence of diagnosed diabetes in circumpolar
indigenous populations. International Journal of Epidemi%gy,
21(4), 730-736.
57
Tables Table 1. Gender and age distribution of participants (N=44).
Age Women (N = 32) Men (N = 12)
18-29 7 2
30-39 7 3
40-49 4 4
50-59 11 1
60-74 5 2
58
\JI \0
Table 2. Pearson correlation coefficients of IPAQ PA scores and anthropometrics (N=44).
IPAQ PA kcals
High density lipoprotein cholesterol (mmoI/L) 0.115
Triglycerides (mmoI/L) 0.011
Body Mass Index (kg/m2) 0.054
Heart rate (bpm) 0.035
Diastolic blood pressure (mm Hg) 0.162
Systolic blood pressure (mm Hg) -0.094
Waist circumference (cm) 0.101 Homeostasis model assessment insulin resistance1 (units) -0.090 Insulin sensitivity index2 (min-' ~ mU/ITI!L_~ ~ .. _ ~.188 _ _
*Statistically significant at p<0.05. **Statistically significant at p<0.01. 1Homeostasis model assessment insulin resistance=insulin/22.5e-lnglucose)
IPAQ PA MET -mins
0.243
-0.155
-0.124
0.024
0.068
-0.144
-0.077
-0.198 0.297
21nsulin sensitivity index=body weight kilograms/mean plasma glucosellog of mean serum insulin
Table 3. Beta coefficients and standard errors (SE) from linear regressions of IPAQ physical activity scores
predicting anthropometrics.
HDL-chol BMI ISI HR (mmol/L) (kg/m2
) (min-1 per (bpm) mU/mi)
Beta SE Beta SE Beta SE Phïsical Activitv Measure IPAQ PA kcals {~er 11000 kcals)
Women Only1 0.025 (0.013) -0.151 (0.074)* 2.509 (2.234) -0.060 (0.310) Women and Men2 0.017 (0.01) -0.061 (0.057) 2.728 (1.773) -0.058 (0.226)
IPAQ PA MET-mins {~er 11000 MET-mins)
Women Only1 0.036(0.016)* -0.192 (0.094)* 3.423 (2.825) -0.053 (0.392)
Women and Men2
Adjusted for age and waist circumference. Adjusted for age, waist circumference, and gender. *Si nificant at :s0.05
High density lipoprotein cholesterol 4Sody Mass Index 51nsulin sensitivity index=body weight kilograms/mean plasma glucose/log of mean serum insulin 6Heart rate 7Triglycerides
0\ o
TG (mmol/L)
Beta SE
-0.007 (0.021) -0.009 (0.078)
-0.011 (0.026)
0'\ ......
Table 4. Pearson and partial correlation coefficients of IPAQ Sitting scores and dependent variables (N=44).
High density lipoprotein cholesterol (mmoIlL)
Triglycerides (mmol/L)
Body Mass Index (kg/m2)
Heart rate (bpm)
Diastolic blood pressure (mm Hg)
Systolic blood pressure (mm Hg)
Waist circumference (cm) Homeostasis model assessment insulin resistance2 (units) Insulin sensitivity index3 (min-' per mU/mI)
*Statistically significant at p<0.05 **Statistically significant at p<0.01 1Controlled for body weight (kg)
Pearson correlation Partial correlation coefficients coefficients 1
IPAQ Sitting IPAQ Sitting IPAQ Sitting kcals kcals MET-mins
-0.371* -0.230 -0.169
0.059 -0.012 -0.068
0.429** 0.208 0.202
-0.042 -0.064 0.089
0.045 0.004 0.032
0.112 0.100 -0.097
0.443** 0.235 0.162
0.201 0.034 0.052
-0.155 -0.033 0.010
2Homeostasis model assessment insulin resistance=insulin/22.5e-lngIUcose) 31nsulin resistance index=body weight kilograms/mean plasma glucosellog of mean serum insulin
Table 5. Beta coefficients and standard errors (SE) from linear regressions of IPAQ Sitting scores predicting
anthropometrics.
HDL-chol BMI ISI HR (mmol/L) (kg/m2
) (min-1 per (bpm) mU/mi)
Beta SE Beta SE Beta SE Beta SE Ph3lsical Activitv Measure IPAQ Sitting kcals {~er 11000 kcals)
Women Only1 -0.053 (0.047) 0.094 (0.202) 2.918 (8.196) 0.126 (1.099) Women and Men2 -0.064 (0.040) 0.043 (0.231) -1.143 (7.257) -0.292 (0.911)
IPAQ Sitting MET -mins {~er 11000 MET-mins}
Women Only1 Women and Men2
Adjusted for age and waist circumference. Adjusted for age, waist circumference, and gender. *Si nificant at pSO.05 High density lipoprotein cholesterol
4Sody Mass Index 51nsulin sensitivity index=body weight kilograms/mean plasma glucose/log of mean serum insu lin 6Heart rate 7Triglycerides
0\ IV
TG (mmoIlL)
Beta SE
-0.054 (0.074) -0.022 (0.064)
Table 6. Female and male participants who met Canadian PA
recommendations and those who did not, divided by IPAQ
categorical scores of high, moderate, and low.
Met Canadian PA Did not meet Canadian Recommendations PA Recommendations
Female IPAQ Activity Level
high 17 0 moderate 6 4
low 0 6
Male
IPAQ Activity Level high 7 0
moderate 1 1 low 0 2
Total 31 13 % of total N 70.5 29.5
63
Figures
7- 18 8
--6-
5-
--
4- --r-
3-
2-
1 Total cholesterol
Figure 1. Box-plot showing total cholesterol outliers.
4 - 18
*
3 - 10 0
--2 -
:
-
1 o -
1 Triglycerides
Figure 2. Box-plot showing triglyceride outliers.
64
90
80
70
60
50
29 o
Heart Rate
Figure 3. Box-plot showing heart rate outliers.
3.00000-
'0 0 "-CP .. II) CP '0 2.00000-.t::
0 0 U
1
..J 0 C 0 ::I: 1.00000- 0 0 0 .... 0 0 0 II) 0 0 ni 0
o 0 ::l 0,... '0 0.00000 " Oc;; 0-. v CP
00 <li>
0:: 0 @ '0 CP 0 0 N -1.00000- 0 00 .. 0 0 0 o 0 c 0 0 CP 0 '0 ::l .. en -2.00000 -
1 1 1 1
0
1 -2.00000 -1.00000 0.00000 1.00000 2.00000
Standardized Predicted Values of HDl-cholesterol
Figure 4. Scatter plot of HDL-cholesterol studentized residuals
versus HDL-cholesterol standardized predicted values.
65
il m .... 0 ln
Cü ::;, '0 'u; CI)
0:: '0 CI) N
:0: c: CI) '0 ::;, .. en
4.00000-
2.00000-
0.00000
-2.00000 -
-4.00000 -
1 -4.00000
cJ) 0
0
1 -2.00000
0
0 0
8 0 ~O
'è 0
o 0 0a o 0
0
0 8 0
v
00
0q,
1 0.00000
0 0
-0
0
0 0
0
1 2.00000
Standardized Predicted Values of SMI
1 4.00000
Figure 5. Scatter plot of BMI studentized residuals versus BMI
standardized predicted values.
Ci) .... 0 ln
Cü ::;, '0 'u; CI)
0:: '0 CI) N =c c: CI) '0 ::;, .. en
3.00000-
2.00000-
1.00000-
0.00000
-1.00000 -
-2.00000 -
1 -2.00000
0
0
0
0
0 0
-"'.
<>0 0 0
-
0 0
0
1
-1.00000
0 0
0
0
0 0
00
0
1
0.00000
0
0
0
ct>
0 0
o
1
1.00000
o
v
o
Standardized Predicted Values of ISI
o
o o
1
2.00000
Figure 6. Scatter plot of 151 studentized residuals versus 151
standardized predicted values.
66
-2.00000 -1.00000 0.00000 1.00000 2.00000
Studentized Residuals of till-cholesterol
3.00000
Mean = -0.0061714 Std. Dev. = 1.01754135 N=42
Figure 7. Histogram of HDL-cholesterol studentized residuals.
-3.00000 -2.00000 -1.00000 0.00000 1.00000 2.00000 3.00000
Studentized Res iduals of BMI
Mean = -0.0049311 Std. Dev. = 1.00953932 N =44
Figure 8. Histogram of BMI studentized residuals.
67
>(,) c CI) ::::J
12
10
8
CT 6 e u.
4
2
-2.00000 -1 .00000 0.00000 1.00000 2.00000
Studentized Residuals of 151
3.00000
Mean = -0.0035743 Std. Dev. = 1.00845073 N =40
Figure 9. Histogram of 151 studentized residuals.
68
APPENDICES
69
Appendix 1: McGili University ethics certificate
70
MCGlll UNIVERSITY FACUl TY OF AGRICUl TURAl AND ENVIRONMENTAl SCIENCES
CERTIFICATE OF ETHICAl ACCEPTABILITY FOR RESEARCH INVOlVING HUMANS
Approval periOd:JwusR'( ~él,oJ - ~<.U).lo.R-'f ,11,05' RES #: __ 'i>~~,;",.1--,--_-,.,.Q,-,I:--=O=-~-,,-____ _
The Faculty of Agricultural and Environmental Sciences Ethics Review Committee consists of 4 members nominated by the Faculty of Agricultural and Environmental Sciences Nominating Committee and elecled by Faculty, an appointed memberfrom the community and an individual versed in ethical issues.
The undersigned considered the application for certification of the ethical acceptability of the project entitled:
Co-Applicant's Name: SUSAN 61RD
Co-Applicant's Signature ~~
Co-Applicant's Name: D Q,."leea Wty)CY't!t
Co-Applicant's Signaturt<c~41 &e~0flf'N<"
( as proposed by:
Applicant's Name GLlI/LtllNk Ctt8fBDNNEfiU Supervisor's Name (JRfJ t~ H. [{iEUWD
App'Ica",', Sig""'""' 4[.,;61& (}(,.,hBlJll(lZiA S"p .......... Sig,,,"", ~ ,41 f"'/ Degree 1 Program 1 Course Hrc tAros -nufz1flCtl, Granting Agency Oes) fa nadlqn 121q,AE7Ff Aw>mt7101
Grant TItle(s}: The emefJNlce tJf ges+aHonal (ilabd:v) "'-tl/dus. anrX drabtl.flme/kfus tllJ1fJnj 'ffle /f1I,uf ff/ rAe .6afi?n
The application is considered to be:
A Full Review / An Ex~dired!Review __
A Departmental Level Review ..,...,...--,.-+'-\~t-.' tL,.,.......,....,..,,--,.-,------Signature of chair 1 Designate
Peter Jones Chair, Faculty of Agricultural and Environmental Sciences Ethics Review Committee School of Dietetics and Human Nutrition Tel: (514) 398-7547; F,aXi' (014) 398-7739 .fI ! i
Signature 1 date
il 1.
fÎl i
! i (lil/J .JCL("I· d Q. è)ûC4 . c..c. . E G--\o..(\6 ; L \-{c~qJl
Las! update March 2003
MCGILL UNIVERSITY FACULTY OF AGRICULTURAL AND ENVIRONMENTAL SCIENCES REB
ETHICS REVIEW RENEWAL REQUESTIFINAL REPORT
Continuing review of human subjects research requires, at a minimum, the submission of an annual slatus report 10 the REB. This form must be completed to request renewal of ethics approval or to close a projecl file once the research has been completed or tenninated. In order to keep the REB records current, and 10 avoid any delays in the release of funds. please complete t.he following and retum it at leasl 1 month before the current approval expires.
REB#: 827-0104
Projett Title: The emergence of gestational diabetes mellilus and Iype 2 diabetes mellitus among the Inuit of the Baffm Region. Principallnvestigator: Grace M. Egeland, Ph.D. and T.Kue Young, M.D. DepartmentIPhone/Email: SDHN/398-8642/[email protected] Faculty Supervisor «(or student PI): not applicable
1. Were there any significant changes made to this research project that have any ethical implications? _ Yes _x_No If yes, describe these changes and append any relevant documents that have been revised.
2. Are there any ethical concems that arose during the course of this research? _ Yes _x_ No If yeso please describe
3. Have any subjects experienced any adverse events in connection with this research project" If yes, please describe.
4. _x_ This is a request for renewal of ethics approval.
5. __ This project is no longer active and elhics approval is no longer required.
Yes x No
6. Vou must list ail CUITent funding sources for this project and their exact titles. Indicate the Principal InveslIgator orthe award if not yOUTself.
Inuit Tapirrit Kanatami ($40,000) and Max Bell Foundation are Funding the Initial Phase of the Projec!. The Max Bell Foundation component represents $15,000 of the $240,000 awarded under the title of "Improving the Health and Health
g::a~;{Vlces in Aboriginal communitt:~oss Norte c;a/(PIIS Grace M Egeland and co-PI is Katherine Gray-
Principal Investigator Signature: ~.f<:.C -11 &Ic-L Date ~j, .2 J; 2 a~-1
Co-Principal Investigator Signature: _______________ Date: _____ _
Faculty Supervisor Signature: ________________ Date: ___ _ (for student PI)
Submit to the Faculty of Agricultural&Environmental Sciences RES, cio Lynn Murphy, Macdonald Campus Research Office, rm MS2-082; fax:5I4-398-8732
(version Jan05)
03/02/2085 14:45
03/82/2e95 e~:51
416'3466055
e514-398-162fJ
l ~DP -K. VCl..-"lG
CINE MCGILl.
MCGILL UNIVERSITY FACULTV OF AGRlCuLTURALAND ENVIRONMENTAL SCIENCES RES
1
EllUCSREVŒW UNEWAL REQUEST/llTNAl. JlEPO'R.T
PAGE !'lZ/02
PAGE 82
Com:ùllrirls review ofhuman subjects researdl requiTu, st .. minimum, the sub.miS&ion of an anlllll1 $tahIS report to tIIe RiB. lbII tbrm mu5t 110 COn1pleted. ta RqVe$t reMWal of etbi~ approval or to elolt a proj&Çl tile once the mearch ha beeD çompI01cd or ~nated. Jn order ~ koep the REB !'CçQrd$ CUITent, and to avoid &I1Y del~ in the relll!e of Cunds. pJase complJlte ~ fuUowmg lnd tetunllt ai Il!a$t 1 IItORth bcfore dK: ~t apptQVÙ expires.
UlM: m..ot04 ProJect TItIe: The aJlergençe of plltional diabtta mel1it1ls and type 2 diabetcs meUltus among the Inuit of the Baffm RlSfan. PrIa_ bvestlptor: Gnet M. B~d. Pb.O. IIl\d T.Kue YollllBo M.D. DepartJUDtlPhoaeJEmlll: [email protected] faea,*, Sapwvitor (for f1l1deat Pl): nOl applicabll
1. Wta Ibere en)' aiBf\ifiQnt chaoS" made to th;. rtSeardl projcct tIIal ~vc lIl\y ethical impliçatjOllS? _y es _~NQ If )'tI, describe the .. changes and sppend I.lIY releV&llf documen~ d1&t bave been revised.
;1. Are tIlerc 8IIy ethical eoncems that U'0ge during lfIe course ofdûs relearch'? _ Y., _x_ No. lfyes. pleuc deseribe.
3. HavI: lIn)I.ubjectR experieneed any adverse events in connection witl1 this retC#Ch projc«1 _ y~ • .f'.~ No Tf )'81. pJease deseribe.
4.. J_ This It. requut for renewal ofc:dtlc.s approval.
s. _ This projtâ ia ''0 IOn&e&' active II1d cttriCS 8pproval is no langer reqUired.
6. YO\J must list all cummt flmdia.& IO~ for tI!.i& projcçt and their ~ titles. In4icaœ Ihe Ptincipa' ln'le$tiptor of tbe .ward ihot )'Oul"&Cif.
CooPrlacipal J.vK~tor Slglllwre:
F'acu!tySupervtsorSipat1lrel ________ - ___ Date:. ____ _ (fat IlUdeot Pl)
Submlt.., tbe Faeult,r of Agricultur::a16:tnironlZlelital SeleDces REa. eJo Lynll Murpny. Macdonald Camp1l8 R_RI! Ofr'cte, l'RI MS2-03:l; ru:Sl40398-873l
(vusfan JanOS)
For Administrative Use REB: V AGR _EDU
__ The c10sing report of this terminated project has been reviewed and accepted
~ The continuing review for this project has be n reviewed and approved
~ Expedited Review
Signature of REB Chair or designate: ---f-H-II--""'.L------- Date:
Approval Period: JAN .2.;1, .2a:6
REB-I REB-I1
Submit to the Faculty of Agricultural&Environmental Sciences REB, cIo Lynn Murphy, Macdonald Campus Research Office, rm MS2-082; fax:S14-398-8732
(verSiOn Jan05)
Daneen,
As per my telephone conversation with Sandra Gibon, Thesis Coordinator, Graduate and Postdoctoral Studies office, for the purpose of thesis submission it is acceptable that the title on the Certificate of Ethical Acceptability for Research Involving Human not be exactly the same as your Masters project title, provided the subject matters are similar. The certificate as you have it is acceptable.
If you have any problems, you can simply refer them to me.
Lynn Murphy Administrative Coordinator Macdonald Campus Research Office McGill University Faculty of Agricultural and Environmental Sciences 21 111 Lakeshore Road St-Anne-de-Bellevue, QC CANADA H9X 3V9 Tel: 514 398-8716 Fax: 514 398-8732
Appendix 2: Nunavut Community-CINE research agreement
71
HamIer of pugairtwtt He&1th SmeuJaaod Research A:reement M., 2005
The CeJitte for Jndi.senoua PcopJ.esl Nutrition and Enviromnent (CINE) agrees to oonduÇt the fOllowing activitics with the guidance and leadetship ortho Pangninung eommUDity.
1. The ovenJlgoals of the eurreat actMties ad Curue plans are:
• to dcvelop an undcntanding of what factors are contributina 10 diabctes and pœdiabetcs amona the llmit;
• to help identify cu1turally appropriate prevention strategies and messages; and to
• pl'QIllotc hcalth through the promotion ofrnditional food and healdJy market: food.
Z. The Ma)- 2005 activiUes fadude:
• a-hcaltb. screcmiDa of adults ov« 18 Yeart of asc;
• an evaluation of a ph)'lrical aetivity questioanaire; and
• înteMews widl iDdividnals living wilh diabetes ft> Jeam about how ta improve dietaty advice.
1bc woâ: bas cthics approval from McGiU University and a Nunawt R.eseatCh License ('#OSOOSOSR-M).
3. COmlJlIwty and CINE PartnmJdp
Community input. advi~ and leadership ia providcd by the comurunity stcering committcc. T'l1e Pangoimmg Health Screening Stccring CoInmtttcc mcmbet$ incJuc1o: Donna. Ki1ab~ 10nab Xilabuk. Johnny Knluguqtuq, and Markus Wndœ.
Community interviewers, Susa Qappik and Jo10 (petet Taylor) Aningmiuq. bave bcen b.tml for the m.onth of May. They will recruit participants, explain the scteeDÎll8 and conduct interviews.
4. CommGDlty Bealtb ScreeD1ng (May ZOOS).
The health screening focuses on diabctcs. pre.diabetC$ and heart discase tbrough ~ of blood tests, bJood pressure. medica1 bistory. diet, physical activity. and bodyweight for beight and petCent body fat.
The health scrccning rcsulta Will;
• mise awarcneas of on.es own healtb statua and health habits to he1p prevent future hœlth problems from occutth1g;
• raisc community awarencss 10 help gui~ development of hea1th promotion efforts;
• holp evaluate the 1àcton that are related. 10 the development of pxe-dîabetes and diabetet amolli the Inuit
ln addition, as there la an mterett in a f011ow-up health assessmem. the oum:m health sc.roc:ninl CID. aetVe as a baselinc lSSCSSltI.eIlt upon whicb ta compare a secon4 future asscssme.ot to hc1p detcrmine wbether hea1th promotion efforts are auçoessful (peIldjns tbat fandiDg).
50 Scope of BcrteDlD.g:
The bealth screeniDg does Ilot address cancer ti!k or othcr healt11 problems lUCh as arthrltis or boue loas.
6. ~itment Aetivklest
• Communitymembers will be asked 10 participate and participation is voluntary. • A brocbure wiU be mailcd 10 each bouseho14; • Community meetings at ANtic CoUego and radio announcemcnts will hU"onn the
commuoity orthe project; • AU particlpan.ta will sigu. a consent fotm.
The health screeniDg will take place al Arotic Collego atartins May 16th and encl by May 2"'. 'Ihc attached consent forros proYide d.etails of what eadl panicipant is expected to do.
7. W~atioD conec:te4 ia to be 1Itared, diatrlb,,-ft(!, aad Itortd bl these agreed ways:
'Ihc data co11ectcd is cozmdential. Interviewers have signed Il confideDtiality ~cnt. Once TCSUlœ are retumed 10 each participant, namcs and bbtbdate$ wiU he rcmoved ÛOUl the database that will he usecl for summary reports. lnfonnation tbat is co&ctcd v.il1 bc bpt al ClNB. A final MpOrt will bc distributed 10 tqional. tcnir~ and national Inuit organ;zatJons after approval ft'Om the community stccring com:nûttec.
Any d.ocument. such as a conference presentation or a publication, will he sbared with the community steering committee for their review. No document or presentation will he
made Without the written tppt'Oval orthe community $teeDng committoe. The ÇQlJ)tmU1ity Dame win or win DOt be used in any presernation depeading upon the wishea of tbe community stecring committec.
8. ProJeet p~ will he eamllMlllleatecl to the eommUllit)' ta. th_ agreed ways:
Bach individual will n:ccive thcir own penonal reau1ts witbin 60 d8)'I of the completion orthe data ~ A visit to thb (ommunity in the faU of 2005 ,. planned te provide summary data of the rcsuhs back. to the oommunity.
9. ()unJDuJdcatioa wUh tIle media ad other parties (ladacUDl foellaC aaeadts) 01ltÂCle the JWDed J'eIIU'dltra .. d the coIDmmdty wIU be Ilacllecl bt. these agreedways:
In t'ho event of media hlte.rest, prior consent hm the COlDlllumty stccring committec will he obtaiœd bcfbro any infonnation is rcJcucd.
FUNDING, BENEFITS, -" COMMlTMENTS
Fundhal
CINE has acqulred taadÎJllad other torms or support for tIûs researdl proJeet frôm:
Inuit Tapirlit Kanatami and the Max '8eU Foundatioa.
J!eMtlts
CINE wilila to use the curreat projeet ba the followtq ways:
• to leam from the cxpericnce to improve the heallh sc.reenin& logi$ties and quea1ioJmairea wbich wi1l \le med na other Inuit communitics;
• te deve10p a relevant physical a.ctivity questi~ that can bc uscd in hcaHh and hca1th promotion rescarch in Inuit eommunities;
• to c1evelop an underatanding of how diet and othcr factors are related fO prediabctic ccmditiœa and to ptesent infnrmatioa on tbeso findings at health confer:mx:es and in scientifie hea1thjouroals;
• to iosœt indMdual and comm.UDity interest in healtb promotion and evaluation of hca1th promotion cftbrts.
Bcne1its likcly 10 he gaincd by the community tbrough ibis project are educatiooal in ~ in that the ptOject Wl11 raiso individual mc1 <X>IlUl1UDity awarencss of cum:nt hea1th status sa tbat the community can decide upon appropriate activitiea to ptOmOte health.
CommJtmegtl
ne communlty'. eommUmedts to CINE are 10:
• Conn a conummity projeot stceriug committee for the bealth scrccning projeot (donc).
• recOl11IlleDd capable aM reliable community membets to ~llabol'lkl'bc cmploYQd in thi& project (donc);
• recommetld lDd guide losistics md queationoairc devc1opm«lt aud to help e<munuaiClte RSUlts back tO the community and iDdividuaJs (donc);
• keep intonDcd on the project pmgress, aQd help in lcading the ptOject toward meanin&fùl results (~.
• provide a location for the hcalth seteeDing (done).
The CINE npreseatatlYa' (Grace EpIad.) l8d her atadmtl (Guylalae CilarbODDeaD, Se Blrd, lDd Daeea Dea.ome) COIIlIIIftmeIlb to the comm:aJdty.re to:
• CoDduct tœ ptOjtct With caro and respect and 10 keep personal information cnn6demia1;
• Infi>rm the coaummity as to the projeet pmgres$ in a clcar and time1y DlIDDet;
• Act as ~ 10 the community for nutrition and hca1th relaùld questions.
CINE agrees te atop the projcçt if comrmmity lcad«s decide ta withdtaw paniclpation, or if the project is succe.ssMly eomplttbd. ft Ï$ understood tbat a timate healtb promotion <:ampaigtl and evaluati.0Il depcnd. upon finding addidonal fUnding.
Signedby:
Cij-' ~. t7~apik Mt)'Ol'. Hamlet ofPangnirtung
~/,:L/ GraQc Egclaiul CINE
Appendix 3: Pangnirtung health screening informed consent
forms in English and Inuktitut
72
INFORMED CONSENT FORM Pangnirtung Health Screening
Principal Investigator: Grace Egeland Ph.D., Centre for Indigenous Peoples' Nutrition and Environment (CINE), McGill University. Co-Investigator: Dr. Kue Young, Department of Public Health Sciences, University of Toronto, Guylaine CharbonneauRoberts, P.Dt., M.Sc. candidate, CINE, McGill University. Responsible Institution: CINE, McGill University. Pangnirtung Community Steering Commlttee: Markus Wilcke, Johnny Kuluguqtuq, Donna Kilabuk, and Jonah Kilabuk. Otber eoOaborators: Looee Okalik, Inuit Tapiriit Kanatami.
Introduetion: We are conducting a health screening to find out blood sugar levels and what factors predict high blood sugar leveIs among the Inuit. Ail Inuit adults over the age of 18 years living in your community are invited to be part of the health screening. This consent fonn will give you a general idea of what the health screening project is about and what your participation involves. Please take the time to read the information carefully and make sure that you understand il
Purpose: This screening bas two main objectives: 1. To find out how many people have high blOOd sugar in Pangnirtung; 2. To find out why some Inuit may have a greater chance of getting high blood sugar.
Description of the study: AIl participants will be asked to visit the Arctic College where an Inuktitut and English speaking team will carry out a health screening. You will be asked about the kinds of food you are eating during a short interview and then you will be asked to come to the c1inic in the moming after an overnight fast (a minimum of 8 hours without eating) for about 3 hours. The health screening will include the following: 1. Face-to-face interview
• Physical activity • Personal and family medical history • The kinds of foods you normally eat
2. Body measurements • Body weight • Body fat composition (for this it will he necessary that you remove your shoes and socks) • Height and Sitting height • Waist circumference (directly against your skin)
3. Clinical and laboratory measurements • Blood pressure and heart rate • Blood samples (after the overnight fast) • Take a sweet drink • A blood sample will be taken two hours after drinking the sweet drink
Your blood will he tested for: • fasting insulin (to find out how well your body can carry sugar and supply your body with
energy); • fasting glucose (sugar); • good and bad fats in your blood; • glucose (sugar) level2 hours after you drink a sweet drink; • adiponectin (shows what the chances are for a person to have high blood sugar problems later
in life).
InitiaIs of participant: __ 5110/05
InitiaIs of witness: Page 1 of3
No more than 3 tablespoons (44 ml) ofhlood will he taken for this study and no amount ofhlood will he placed in long-term storage for future tests. No other laboratory tests will he done.
Right to refuse participation: Your decision to be part of the study is completely up to you.
Risks of participating: • A bruise or tendemess where blood was taken. • Symptoms related to low blood sugar after drinking the sweet drink, such as weakness,
fatigue, and hunger, and in some cases, anxiety, nervousness, trembling. These symptoms are easily treated hy the nurse and can be avoided by taking a light lunch which will be provided to you at Arctic College at the end of the health screening.
Reason why it may be useful to you to be part of this research: After successfully finishing all parts of the health screening, you will receive your results in a booklet (in English and Inuktitut) within 2 months. A general summary of the results will al50 be presented to the community in the faU 2005. Everyone participating will receive information about how to prevent high hlood sugar. You will al50 receive a CINE baseball cap and your name will he put in a draw for a variety of prizes.
Confidentiality: • The interviewers have signed a confidentiality agreement and the data collected is confidential. • You will be given a unique number to keep your identity confidential. • We will keep a copy ofyour name in a locked cabinet in the Centre for Indigenous Peoples' Nutrition and Environment (CINE) director's office 50 that your results can he returned to you. • Once your results are returned to you, your name and birth date will be removed from the database which will be used for the summary report; only your number will be given to those looking at the data. • If you agree, your personal medical results will be given to the Pangnirtung Health Center. • No other personal information will he shared with any community member, organizations or other agencies. • Only the overall findings (not your personal results) will be shared with regional and national Inuit organizations concemed with health.
Right to withdraw: Your participation is voluntary and you can stop being part of the studyat any time. Also, it is okay if you do not answer some of the questions. Please ask any memher of the health screening team if there is 50mething that you do not understand. Al5O, you own your personal data and can at any time ask to have your own personal data removed from the datahase.
For more information, comments, complaints or to withdraw from the study, please contact: Susa Qappik, Phone number: (867) 473-8567 Jojo Aningmiuq, Phone number: (867) 473-8559 Johnny Kuluguqtuq, Phone number: (867) 473-2632 Grace Egeland, Ph.D. Phone number: (514) 398-8642 Kue Young, M.D. Phone numher (416) 978-6459
InitiaIs of participant: __
5110/05 Initiais of witness:
Page 2 of3
INFORMED CONSENT FORM Pangnirtung Healtb Screening
1 have read and understood what is involved in the study and agree to participate in the Pangnirtung Hea1th Screening.
YesD NoD
1 give permission to the Pangnirtung Hea1th Screening to send my medical results (blood pressure, blood fat, and blood sugar levels) of the health screening to a medical representative at my local health clinic.
YesD NoD
1 give permission to the Pangnirtung Hea1th Screening to find out if my blood sugar has been tested in the past and what my results were. 1 give permission for my full name, date of birth, and hea1th number to be used to find out my information at the Baffin Regional Laboratory (based in Iqaluit).
Yes 0 Hea1thNumber: _______ _ No D 1 give permission to the Pangnirtung Health Screening to contact me within the next 5 years for a follow-up hea1th screening.
Name of participant
Name ofwitness
Name of principal investigator lor bis designated representative
YesO
Signature
Signature
Signature
NOO / /
Date (ylmld) --
_/_/Date (ylmld)
Participant's address where results are to be sent and phone number
A copy of this consent form has been provided for you. Please keep it for your records and future reference.
Consent explained by: _________ _ Date (ylmld): _______ _
Questions answered by: _________ _ Date (ylmld): _______ _
Initiais ofparticipant: __ Initiais of witness: 5/10/05 Page 3 of3
ccnn. <lc-" <l'''?C <""cr'ijr ,,~~~ 'icroa. nr~< 'ib.DA'" cr""L.D'"
"~I'-Q.,acn~ ~~C~..e": (JCiA" Arc... L), Grace Egeland, àc-L cr~~L ~~<I"')"', .Da..c-)"...,lre à.D 'f'L .D L cr'P'f'L.De <ILL <I~nJ"" Lrl>< Ac-L cr<ll\ 'O!<I'L "~H"'''CI>..(/' (d 1r~1 Dr. Kue Young, <lLcr<f)C-~~ "I>i'-""~N, )~)< Ac-Lcr<ll\'O!<I'L, rc...àL ""<.D-~>"'. àc-Lcr~n. .Da..c-)"......,lre A.D'f'L.De cr'P'f'L.De <SLL <I<::nJe, Lrl> àc-Lcr<ll\~~~
A~~~ A~~<I~~l>cr<l~)J" bL~l>cr<l~)'Io: . .Da..c-)"...,lo-e à-D'i'L.D" crn.."Ccr'J"" <SLL <I~nJ"" Lrl>< àc-"cr<ll\~<I'L <';'1r <'o.Ar'J"" bnLI'-Cj~ C; Lb" I>AI>P, ~cr cr-~?~) ... , éa.. 'Pc... <<"', ~Q. 'Pc... <~ ... <lr"f''' A"Cl>r+. ~ 1>1x-", à-DAC ~c ba..cr.
Q...,a,.â vr<l?': I><!J" c- I\c-t\. <I"CjCC orcJC ".oâ" cr~r~ "I>Hr<l~cr~r~ <l1>~dC rb "..,<I~cr~· <ILL Pr l\-..!or .. ..,:)J ULâOOC\. 'l.'Io <l1>·cJC rb%..,<I~crl>-..!'Io â-D'" .0.... â.oâC â"'~'" <lCjJ~c 18cr· I>'l.ë.o'" .oa..r'crrl>Cc I\"CI>-..!"'a..O<l~ CDJ'l. "1>Ï""Q.r<l~cr~J"'. I>a.. <l'f'mrlo-n.<I''')'Io ccnn..<1~· %1>Ï""(..,-..!nr-..!"'a..cr<lUc %.oAcjC'L 'l." <lcr<lC'a~Lcr'J'" %1>Ï"" .... 'cr'J .. Ac-t\. <l'''Jcr<l~)J'' <ilL A "CI>Llo-~cr~cr·. <In )Pr'r<l?n .... C I>%c-L cO<lV" cr<l%nC <ILL )Pr'O<lCjr<l~..,rc.
A~n'l.: I>a.. %I>~""~cr'lo L?..,<lëcr· )CjL%~r<>'Io; 1. "1>Ï""-..!nrLr<l~..,J "cnc <l1>·dc ~d)â"a..â" â.oâc rb"..,<lc-'L 'LC <"'cr~jr: 2. %1>Ï""-..!nrLr<l~..,J rIlL'" âc... 'f'''' â-Dâc <l1>·cJC rb%..,<I~cr~r· I\crl> .... cr~ .... I>C~L 'LC
Q...,~VLcr..... ~I>~" ~crl>~<: 1\ ~Cl>cr<l~)c-l:.. .. ~ c... C) .... 'l\.J\Jlo-I>L!oo-'dc C <!cr..,:) â-DcO)C <ILL % .. ..,~O)C 1>%?"'a..~)C %1>Ï"" .... ~cr'r· 1\~n.<I%Cjlo-~. <lNr'CI> Llo-\Jnc %.oâC)cr· cr~cr· crn. <!LL ..... 'N CL ... a....,:) ~c...r d~Cjlo-~)'Io <ILL <1 cr <IN j\J!oo-I>Llo-~)OC I>'-~dc A « .... 'l.Jc 1>" .o·dc crn..c...I>'f''' ..,nc (& "'a..<..,c âbCjC 8 crn.c...I>'f''' ..,:)nC) <lcr<l/\Ltblo-~)n· âbCjc I\'l.r<..,:)âc• CL"'a.. "I>Ï"" .... ~cr'lo âLâC)cr· I\C%Cjlo-\J'Io: 1. ~~"'~I>..,nc
• OrN <l1>c...!oo-"crt\. <!cC'l.cr· • â<N <ILL âc...N <lcr<l"~"C~r'Lcr'f'C r~.o'" • ".oâC)cr· cr~cr· crn." ..,<lC~<LL 'l.~N
2. nrl>< I>C)4j'Cl>cr ..... • 1> \JLâ .. ci-c
• OrN I>~"'%~cr'l. (t> J'l.c- %1>;0.. .... ~Cl>cr<l~..,OC br c...t\. <I%Cjlo-\Jnc <ILL <I~~r'P N..,:)r·) • CP~C <ILL âr'<!~..,:)nc cPci-c • ~nc 1> )'CI>..,cr (â <N I>t-.crc...n. 'l.Jc)
3. <lcr<l/\Lr <ILL ~I>~" 4j"l>cr~J" I>C)4j'cr'lo • <lI>N n"~~cr'l. <ILL t>LMc n'-~~cr'l. • <l1>'f'~CI>..,:)ne %1>Ï"""Cj .... r· (1)'' .o'l.cr crt\.c...I>'f''-..,ne) • âr\Jlo-I>L!oo-'r -..!nc r"a.. ')r· ârL .... r·. • L?· âbCj· <lcrJc...I>,o .. ..,r· âr c...1>'O" ..,Oc r'~a.. ')r., <l1>'f"Cl>b"'crCj!oo-~dnc %I>?--.... Cj .... r·
<ll>e "I>Ï""" ~CI>Llo-\J'Io I>d.o 't.: • crt\.c...I>'f' .. ..,:)cr rb"~crt\.lo-'l. ("I>;o..a..,Jor ..,:)J Orc ".oor rb"?"'a.. \. 'l.'Io <IlL
<l1>c...lo-J'" a..cr"'cr·) • cr~c...I>'f'''..,cr "'b%~crn.lo-'l. • AC%'cr'l. l>'rO<l<!· <IlL l>~rblL· â<N <l1>'l.cr • rb%'cr'l. AbCj· Li>· <lcrJc...I>'n" ..,:)r~ Arl ..... r· r"a.. ')r~ âr c...1>'n'-..,:)nc
• I>'r%'cr'l. (%I>Ï""-..!OrLlo-~)'Io <lbl>'f'c-l>mrLlo-~L 'l.'Io <l1>·dc rb%..,:)<I'cr'lo ~r'n.cr<l~Ccr. ~cr""'l.cr)
Q...>a.AY.,.'\, A"O>~ __ Q.">a.A Y cr '\, ccr-Q. ')<:
5/10/0S Page 1 of3
<I~nci~ C A 'l.,~L!r'C')C <l1>'C'V t\1>a-".o" CUJ'l., %I>~L., 1a-I>L!rI)J" <lLL~ <ll>b <lda-I>-'!J" Ar'L!rI>L!r"'f)C r'>a-L.,r %I>~L.,GL.,I> ~nb. <lr'<lJc %1>~L.,Ia-I>-.!rb AC%G!r"'r)lb .
.h..c....r!rl>lbcl>a-<llj< IPA-,J"Q}a-'l.,: A%CI>-.!La-f"\.!rt.c I>~~a-" NbCI>-.!La-'C'dN t.rLI~n~c...~ c .
.h..,-IL-,nre-?"a..I)C .h..c....r!rl>lbCI>a-IJ .. : .-. <II> 'C'V t\1>a-dbdc n~ ~!r?-.!e-)t. .. a..f"\. <1% I)nc. • t.~a-d~ ~ t.c... 'C''' t.Lt.~"'JLr-.!C <lC)ICI>a-Ib~"'JLr-.!C <l1>'C''' ,-Iblb'C' ~<lln>rc r'la..l)rb
t.rLL.,rb t.r c...l>ln~ ~rc, t.Lt.cj-.!"a.. Idc .oPP ~a-, CIbL.,Gt. ~ ~a-, <ILL b~a- <lLL~ t.c.... 'l.,Jc, b<A<I,-I?-,!~ ~a-, .h..,-IL~?-.!~ ~a-, I>?~?-.!~ ~a-. Cd<le- <la-<lr'l>lnJ" bLr!rl>cn<l?"a..l)C <ILL Ct.Lt.'C't\L.,l>r~~a- a-f"\.<lI-.!~~a- t.e-".o" AClblnCI>L!rf"\.>1b r' c... C)L., INr Ibl>~L., ICI>r'L!rf"\.e-?N.
A~n'l., ,-ILL" .h..e-.. ..I,. .h..b-..!lcrlb?"a..IL 'l.,1b AlbCt>"cr?N CL)J'l., 1bt> .... L.,lcrIJ .. : CL "a..ebLr!rf"\. <llbl)1b A!rf"\. VL cn<le-Ibc 1b1>~L., Ia-IJ", nnlbl>r'<lG!rldnc (Ib~ ~~n)C <lLL~ t..ocmc) ClÎ'b L?b <la-Jc....l>ln .. a..rb. ,-le- a...h..a.. Ir'LL~<lI~a- Ibl>~-.!nr a-I>-.!c L., IPICI>L!rn.>c .oa..e-L J" t>P<I"L., lb 200S"'Je-Ibc. A IbCI>-.!e-L" )Pr'r<lmL.,a-b A-.!.h.. .. a..I>L!rldc Ib.olb bL cn<l?"a..a-Irb <ll>bdc ,-Iblb~<llae-L -.!"a..a-Irb. a.. L., IClnCI>L!rf"\.>nc <ILL <lne-I>ICI> ~nc <lJ!r"L.,I>L!rI).o" <I!Ti"-r'C'? ~!rl).o" A -.!r' <lL.,.o".
t>Ib-,PCn. <lib 'C'''crlb: • <lAIb,-llbnl>-.!c <1 ne-I>Ibr'L>c .h..lbdrC)a-c a..~a..t.!rt.r<llb?n <lLL~ bnlb,-lIbCI>-.!c I>Ib~PCcCl>r<lIbGn
• Cd<l~ t.c....r!rI>%CI>-.!c .h..~dc ~ L.,l>nlblnCI>L!rldc Pa..e-LJ" %1>~!rI>L!r'C'LL". • )Pr'r<lmL.,t. ~ ~ %GL.,I>!rIJ" t.e-!rI>L!rldc. IbGL.,I>!rlr e-IbC t.e-" .oC )Pr'!T-.!nl>-.!c
)a-I?CI>-.!L Ib)C t.e-" .oc. • 1b1>~L.,t>nr a-c t.e-".oc 1> nlbnCI>Jn, <lnc t..ot\r a-.... ~ A IbCI>L!rIb)1b lb 1> i"-L.,I> na-c l>a-bbJc
t.c...e-I>CI>-.!"a.. G!rlb)n <lne-!r"'C'''" ~n I>PI> .. a-.... ~. • Cd<l~ Pbda-'C'C <ln'C''' Pr'L -.!rnCI>L!rldc .oa..e-)lbL.,!rI>-.!.o" lb 1> i"-L., 1t\I><:C)r a-"P.o" <lLL~ <I~nJ" <l1>c.... cn~LLn.I>< <l'-c...t\ 'l.,a- A-.!nr'-~J %I>~-.!CI>-.!c 1\ IbCI>r'L -.!J" I>n1nCI>-.!"a.. G!rILC IbI>~a..rC)lbe-lbc. .
• t.<N r~.o'l.,-,!c )Pr'-.!nL.,c lb 1> Ht.-.!nI>L!r 'C')C Pa..)t."a..IJ" .oa..e-LrI>CI>-.!J", b)~lbnr J" I>~~a-" nrl>-.!.oL.
• Ibl>~-.!CI>-.!c AClbG!r'C')C t.<N <ln'l.,a-b I><~~a-" 1b.ot.C))t. "a..lb )Pr'r <1 mL., lb <I)ICI>-.!"a..l)1b a..~a..t.Ir'-.!nI>J"a..G!r'C'c...1b pa..r'l.,IL 'l.,1b.
• Cd<le-L" 1b1>~L., ICI>r'L -.!e-L.o" bnCI> ~nb Ibl>~-.!nc (t.e-" .oj'l., 'C')Ib) lb 1> Ht.-.!nl> J"a.. G!r1dlb <lN)VL -.!r <lLL~ ba..cr t..ot.c b)~lbnr'C'''.o'' <la-<lI)e-f"\.a-1J" t.rL~nlbl).o".
A-~"a..lcrn.!r.h..C NbCt>-..!LJ"cr1cr?N: AlbCI>-.!La-n.!rt.c A-'!La-1.o" Le-)t."a..G!rIL" <ILL Ib'l.,)t."a..n<ldc Ibl>~a..,-I"a-IJ" N"a..f"\. '-~nc. ,-le- t.c.... 'C'''a-b <lNdr'I>-.!a-b PI>-.!L "a-'C'dN PI>'C'J"a..n. '-~nc. <In <lAn.a-<lldnc Ae-n. <llbl).o" 1b1>~L., 1a-1J" )Pr'n<la-'C'dN. re- t.Lt.cjrLL" Pa..).h.. .. a..lb Ndnlb 'l.," Cda-'l., 1b1>~L.,?CI>r'L -.!a-b 1b1>~-.!nl>r'L -.!a-b <ILL Cd<l t. <N r~.o" nncilCI>r'L -.!c C ~'l.," )Pr'r<lIt\I>-.!" a..l)r" NCI> IdJNc Ct.Lt.J" a..n.>Ib.
)Pr'r<lba-?LJN, t>lbl>r'L., Ib?N, <lb 1> '" 'C'dN NL "a-?N Ibt> .... '" ICI>a-1J", IbI> .... b? .. a.X.h..c a..e-<l).h.. .. a.. lb rL., ibN, I>lbc...l>n'l., (867) 473-8567 -.!-.! <l''a-1rl>lb, I>lbc...l>n'l., (867) 473-8559 !ra- d .... ~?I)Ib, I>lbc...l>n'l., (867) 473-2632 JGt." t.!Tc.... .. (Grace Egeland), Ph.D. 1>%c....l>n ... L (514) 398-8642 J !rb (T. Kue Young), M.D. I>lbc...l>n'l., (416) 978-6459
5/10/05 Cl...-,0....6.(r'<T"L ccr-a....~)<:
Page 2 0f3"
-=> v U .1 .t:. ,J' ';p v ...., r ..J b v ..JC v
1:: ~b ~. .t:..t:. ..J -y Cl v)- d ..J ..J;f ("'\ ..J v, o V ~ V 1..,
J~ J~ ( C'M
::k<;; ) 1.., J d Cl)
u J1 l"oo UV b<;; D Vro
~b -y b LV .6. T~
;f A..·V C b
v
If If "If 0 b .t:. ...., -.J V" '-
b ,J';f -Vv V :i 1 .t:. ~ v-V V Y..J"d ·v "I~ "I~ "I~
d , b ê.t:. .f..J b ê
, d 1"\-
.("'\ A.. V ~ b
<t '1~ .t:. -'1 '1 , ~ ~ ~ b ,J''b,J' ~d
..D c... Cl d-v c 1 1 ,p d..J ~ L <1 ~ 1"\- J J
-y~ C<;;- -y v .6. .6.
C.t:. <1 c... ..... .....
D D ).Cl~b D II.. r r "
u U ..D .6. Cn.. A..' !Jo !Jo b . J.f /<1;f .t:. b r ri> v v ~ d ,J' v'1
..... ..... .f-, ~ .t:.A.. ~ n..-<;; ~ C L r r A.. v ·V v.t:. 'V VC~ b ·V .6. .f ..., ...,
d .t:. b ,J' c.... .f J b v- v-A.. VA.. ..D q ,p'J ~ .t:. ri> "
V V
u d .t:.r.t:. bu .6. "\.. ....) A.. -y Cl ,J' ,J' dn.. .1 .t:. ~ tv Vv -.J -.J
b d,p .t:.;f .t:.c.... V- V-·U s= b bC '1 A..
d ~b \..v -Vu .u .t:. r r r v c <J d,J' D .t:.Co...
-.J
D .JOb ,J' D "\.. "\.. "\.. :i ri> q ;f;f A....D C d9- i' l"\- I"\- l"\- V
-v" .6. .6. .6. v-.t:.\.. v d C d b
..D '1 b rI'..J \..-y .t:. .t:. b l. l. l. , -.J
"" J d d< b c c c ..., "\...<1 ~ Cv v v V .6. "\..
.<1 ..J .<1 A.. • '1 " v .f '<1 <
~ Cl V \..A.. v v .t:. .. .t:. ("'\ c A ("'\,p L - rl'bu " d.t:. ~J ·c L .("'\ d -yn.. V A.. ri' v
v ~ Cl L..J v 1.., .t:. .6.
C ..J.t:. ... b;f '("'\~c.... <;; ri' d v C
..J L v .t:. "\... b ~ " .1 V c y b v ~
;1- ·bu~ b LO 1 -.J .6.
ri' y-y("'\ V v
b d "\.. ~ u L ;f"). rî: b V .("'\ 1. .6.
n.."" r'("'\ v d V '"lI
b-, -y 1>.
c....f "v ",.t:. tri' v'1 ur ~b v
.1 Â- ..J b Cv .1 ("'\ II.. .:.i '" ~.I C..J dd
yv v-" .6. r .:.i < VA u .t:. .J\. 1-.J ri> '.6. v y Cv V ..J -v D -=> J"\.. V .L>- T
ri' ..J~ d cV.t:. ;f.t:. s= l. r 1 r • blr) JI 1.., b J '-0
LL ~ - d~ u .(\) ." 'A "\.c C II.. v T 10 ..Dv -yd d bn i b
l"\- V 1 ~ b < Cl '<1 cb .6. ~d v- -" V·n .t:...J ~;fV v ,.., L>-
, ...... ;f v ..D ri>
, .6. 1 v
1 a... dV)
~"" -y c\.. < ...,
ri> V " .-y
r) r)r v .6. d
C b re d-=> r r r) L>- c .~
" JI.., vrP..J ~ A.. v 1"\- u
~ u ol v,p -v.t:. T 1"\-..D..J C C C,.., ri> c...
uV .t:.< .t:.C .t:. \.. d <,p v v vi < v v
Appendix 4: Physical activity validation study informed
consent forms in English and Inuktitut
73
INFORMED CONSENT FORM Physical Activity Validation Stndy
Principal Investigator: Grace Egeland Ph.D., Centre for Indigenous Peoples' Nutrition and Environment (CINE), McGill University. Co-investigator: Daneen Denomme M.Sc. candidate, McGill University. Responsible Institution: CINE, McGill University. Pangnirtung Community Steering Committee: Markus Wilcke, Johnny Kuluguqtuq, Donna Kilabuk, J onah Kilabuk. Other collaborators: Looee Okalik, Inuit Tapirit Kanatarni.
Introduction: We are looking for people who have volunteered to be in the Pangnirtung Health Screening project to be part of this study. Please take the time to read this consent form and make sure that you understand it.
Purposes: 1. To use a questionnaire and a physical activity recorder to measure physical activity levels
among Inuit.
Description of the study: The results from the physical activity questionnaire that you will fill out as part of the Health Screening will be compared to the results of an activity monitor.
You will be asked to do two things: 1. Come to the Arctic College to get your height and weight measured. 2. Wear a small physical activity recorder called a Caltrac that will measure your physical
activity. You will be asked to wear this for seven days in a row. It clips onto your belt or pants at your waist and is about the size of a deck of cards.
Important things to think about: • Wearingthe Caltrac activity monitor will not cause you any harm. • The results will be entered into a computer pro gram but it will not include your name; you
will be given a number instead so that the people working with the results will not know your name.
• We will keep a copy of the names of participants in a locked cabinet in the Centre for Indigenous Peoples' Nutrition and Environment (CINE) director's office so that results can be returned to the individuals participating in the health screening. (REMOVE)
• No personal information will be shared with any community member, organizations or other agencies.
• The findings will not include names or any information that can be used to identify individuals.
• Only the overall findings (not your personal results) will beshared with regional and national Inuit organizations concemed with health. * You have the right to stop being in the study at any time and to withdraw aIl of your
information.
Benefits ofbeing in this study: 3. You will be helping to make physical activity measuring simpler and more accurate in the
future. Everyone participating will get information about how to prevent obesity. You will also be given two extra raffle tickets for the draw. You can double your chances ofwinning!
InitiaIs of participant: __ 5/10/05
InitiaIs of witness: 0-'2.Page 1 of 2
INFORMED CONSENT FORM Pangnirtung Health Screening - Physical Activity Validation
l have read and understood what is involved in the study and agree to participate in the Physical Activity Validation Study.
YesD NoD
Name of participant
Name ofwitness
Name of principal investigator for bis designated representative
Signature
Signature
Signature
/ / ------Date (y/mJd)
/ / ------Date (y/mJd)
_/_/Date (yfmld)
Participant's address where results are to be sent and phone number
A copy of this consent fOrIn has been provided for you. Please keep it for yOUf records and future reference.
Consent explained by: __________ _ Date (yfmJd): _______ _
Questions answered by: ~ ________ _ Date (ylmJd): _______ _
For more information, comments, and complaints or to withdraw from the study, please contact: Susa Qappik, Phone number: (867) 473-8567 Jojo Aningmiuq, Phone number: (867) 473-8559 Johnny Kuluguqtuq, Phone number: (867) 473-2632 Grace Egeland, Ph.D., Phone number: (514) 398-8642
Initiais ofparticipant __ 5110/05
Initiais ofwitness: __ Page 2 of 2
ccnn. <lc-~ <l"'-r?' <"'cr~jr ~bt>jIo-" ~cr~ nrt>< ~b..Dâ'" cr""l,..D'" - nrt>< <lt>c.. %CC~cr""l,..D'" %t>jIo-r<l?'
~bl>~~Q,n""~<ln: J~~" ~rc...". ~e-"a-<lQ,r'L~-.:!<lQ,)Q,. Ae-r..N ..oa...%Q,bQ,)..oc a-\fI"'f .. ..oc <I~n'\.," ..0 .... ...). Lrl> ~e-"a-<lN-.:!<lQ,
~1>~~Q,nl>"'bn'\.,: Ca-" n..oL. Âe-"a-<l\l.n. Lrl> ~e-"o-<lN-.:!<l1I. Ae-&.cr<lAI>'I!<lQ, r<lcrQ,r''I!Q,: Ae-r..N ..0 a... "bQ,bQ,)..oc cr\fl"'f"\J..oc <I~n'\.,..o""...)
<&'o-Q,)t;I, ..DQ..e-'l..C bnL~ "'fc; Lb" I>ÂI>P. !:ra- d .... ...)?C)t;I,. Ca... \fic... <~\I,. -.!a... \fic... <~\I, <lr''I'C Ae-n.. "'bCc: ...)~ I>be-\I,. ~..o~c CAr.. C ba...cr
Q.....)a..A ~r''I!c: I><J .... e- ~Po-~cC A..D "cr~ èdcr'l.. A "'bCI>-.!Lr'L 'l!cr~ <'cr~jr~I>~~ ~cr~J" nrl>< "'b..DA "cr'l..cr~ Ae-n.. <1..1'" "bl>~~ ~crl>< Ac..r .... ...)crl>~. <In I>Q.. <l'''f?C nm~Ar7n.. <le-~ I>"'be-L ~cr<l"'bc <ILL )Pr'n<l~"'<I~...)J.
A-.!n"'f~;
1. "1>~-.!nrt."'<I~~J <lA ~d~l>-.!c nrl>< <l1>c.. "bcC~cr'l....D &. AI>~LL '1.. Q, ~1>l'-~?CI>...)cr "..DAe-I>~crl><C)r~ "b1>l'-"'I!nrL7~L" A..DAc A "bAe-~Cn<l<LL 'LC
Q.....)a..A7~r'Lcr'l.. %I>~~ ~crl>~<; "b1>l'-'I!CI>'I!c nr~dc <l1>c.. "'bcC~crl><cj< r~..D'" <lNd~nJC Ac..rcr<l"b nrl>< "b..DA"'cr'l..cr~ "'b1>~~~cr~..I'" <ILL ~n!rI>L7~)cr nrl>< <l1>c.."C~cr'l....D'" "b1>~~?CI>~L 'l!Q, <ILL...) "bl>l'-~ ~crl>~L -.!..l''.
CALe- L? .... ...)<lècr~ ALA~d71>\,7~dnc: 1. ~c... C)~ ~Aj~d!:rl> ...)nc "bl>~~ ~CI>L!:r~L" cp~c <ILL l>~dL~"~c 2. <I)~...)nc ~<N nr'\.,~~b!:r~)r~ "'b1>~~l>nI>L!:r~)r~ <l1>c...!:r)nC "b..o~e-I>~a-r..~cea-~.
éa... "b1>~~l>nl>-.!\I. <I)r..<I"b~!:r"bC 1> .... ...)..0 ... 7..0 .... \fI...)<I..o" <I\fIJ"a...~)\I. I><~':'a-" "b .... e-.. ..o ... <I"'fa-'\.,...) LpcCl>nn)C <l'''fo-''b<..,,c)a-.
• <I)~...)J "b1>~~?C <l1>c...!:rC)nC "bI>Âe-I>~a-r..!:r"a-~ éa......) 11e-"a-~ "b..oI1e-~~"'f)\I.. • "bl>~-.:!Cl>-.:!c "b~~1>7~J~CI>L!:r~dc P~<la- <lnc 11e-!:rI>L!:r"'f)II.; a...LLc~nCI> )11"a... ~!:r~dnc éd<l
Ae-r.. <l''b~)C "b1>~L!:r"'fLLC Pa...l>LL '\., ~N. • ~<N r~..o'l..-.!c )Pr'-.!n~c "b1>~bl1-.!nI>L!:r"'f)C Pa...)~"'a...~J'" ..oa...e-LfI>CI>-.!J ....
b)~"bnr ..1" I>~':'a-'" nrl>-'!..o". • "bl>~-.:!CI>-.!c AC"b~!:r"'f)C I1<N <ln'\.,a-~ I><~':'a-" "b..o~C))I1"a... \1, )p~r<l?n~ \1,
<I)~CI>-.!"a...~)'* a......)a...I1~r'-.!nI>J .. a...~!:r"'fc...'* Pa...t'\.,~L '\.,'*. • Cd<le-L.'" "bl>~~ ~CI>~L -.!e-L...o" bnCI> ...)n~ "bl>~-.!nc (11e-" ..oj'L "'f)'*)
"b1>~b -.!nI>J" a... ~!:r~d'* <lN)~~L -.!J" <ILL...) ba...cr 11..011 c b)~ "bnr"'f" ..0" <la-<l~)e-r..a-~J'" ~",L....)n"b~)..o".
• A -.!"a... ~a-"b ~dnc "b '\.,)11'" a...n <1 dC NbCI>-.!LJ ... a-~a-?N "bl>~~ ~a-~J" ..0 "b?"a... ~dnc.
Ab~nr-.!c "'bl>l'-~ ~cr~..IL l1c...r7I>cr~f~: 3. ~b-.!~!:r~dnc nrl>< <l1>c... "b Ca-'\., JC "b1>i'-!:rI>L"'<I~n""...)J A!:rr.. <lPLa-~~I>L!:r~L" <ILL...:!
,Je-a-~~I>L!:r~)a- ~:>a-~I>a-<l~)r. Pa...)~ La... II. A "bCI>-.!'* )P~b"a-?"a... ~!:rld'* "b..ob"~'* ~dl1cn...:!<I!:r~VL ~f~. ,Je- )a-r'!:rI>L!:rr..:>nc L?"a-~ <lJ7-~I>L7-lja-b. CI1Le-~c... "b?"a... ~~c <lJr'-.!"be-"bc ~c... "b?"a...)~ "a...r.. <l''b~a-I~I>L7-ldnC!
Q....;>c~LI.'r'cr't. A"Ct>~< Q....;>o..L\'r'cr't. CO'o..')<; __
5/10/05 Page 1 of2
een(\. <lC"'"~ <l''''f'?C <"'cr~jr ~bt> .... , ~cr~ nrt>< %..oA o..cr'l...o 0.. - nrt>< <lt>c.. %Ce~cr'l..D 0.. %t> .... r<l?C
t>~'L t>%C'"lVl~'L <ILL )Pr''-...:l 'L Ca.. %t>r--~ ~crq, %..oÂ.cjcr<l~cr'Lcr~ <ILL <l'''f~d'L A %Ct>~lcr~crb <'cr~jr nrt>< %..oÂ. "cr""l..crb %t>r--~ ~cr~J".
<ln't.. "I>""a..,..cn~ -,,<lC< I><~':'cr P\,,)'.,..<1'..>cr nc-r'L!r't..
/ / <lGJ't../CIP't../I>'--" 't..
/ / <lC;J't../CIP't../I>~ ..> 't..
/ / <lGJ't../CIP't../I>~..> 't..
<Ir?' a....><>...6.'c't.. I>L: _________ _ <lGJ't../CIP't../I>~ ..>'t..: _______ _
<t\'di" PI>!r'1'~ I>L: _________ _ <I<iJ't../C'P'I./I>"" ..>'1.: _______ _
)Pr'r<lbO"'?LJN, t>"t>r'~ %?N, <lbt>~ "'fdN NL LO"'?N %I>~~ ~CI>O"'IJL, %1>~b?La.. ~CAc a..c-<l)ALa.. q,:
~cr d'-->?~)q" t>%c...t>n""l.. (867) 473-8749 J<iÔ," Ô,"c... .. (Grace Egeland), Ph.D. t>%c...t>n""l.. (514) 398-8642 ci 7- b (T. Kue Young), M.D. t>%c...t>n"l.. (416) 978-6459
o....>o..A'r'cr"L A'bCI>~< __
5/10/05 o....>o..A'r'cr"l.. c.r-o..')<: __
Page 2 of2
Appendix 5: International Physical Activity Questionnaire
(IPAQ) in English and Inuktitut
74
STUDY NO. 1 N 1 U 1 0 1 1 1
< .... crlijr n rI> < Iib..Db. IL. cr ""l,..D 01.
lib 1> r---" licrlilo 2005
~ c- f~<1fJ nrt> < <1t>C-7l- ~ fCa- ttt-..J:J ... <1l1ync
INT.NO.
Pangnirtung Health Screening 2005
PHYS/CAL ACTIV/TV QUESTIONNA/RE
1 nterviewer -Completed Questionnaire
Centre for Indigenous People' Nutrition and Environment Macdonald Campus of McGiII University
Completion Date: JJL'_'2005 m d y
_ .......... _I ___ L ___ n~
Time:_'_ h m
INTERNATIONAL PHYSICAL ACTIVITY QUESTIONNAIRE
We are interested in finding out about the kinds of physical activities that people do as part of their everyday lives. The questions will ask you about the time you spent being physically active in the last 7 days. Please answer each question even if you do not consider yourself to be an active person. Please think about the activities you do at work, as part of your house and yard work, to get from place to place, and in your spare time for recreation, exercise or sport.
Think about ail the vigorous activities that you did in the last 7 days. Vigorous physical activities refer to activities that take hard physical effort and make you breathe much harder than normal. Think only about those physical activities that you did for at least 10 minutes at a time.
1. Ouring the last 7 days, on how many days did you do vigorous physical activities like heavy lifting, digging, shovèling snow, or fast bicycling?
___ days per week
D No vigorous physical activities __ ... ~ Skip to question 3
2. How much time did you usually spend doing vigorous physical activities on one of these days?
___ hours per day ___ minutes per day
D Oon't know/Not sure
Think about ail of the moderate activities that you did in the last 7 days. Moderate activities refer to activities that take moderate physical effort and make you breathe somewhat harder than normal. Think only about those physical activities that you did for at least 10 minutes at a time.
3. Ouring the last 7 days, on how many days did you do moderate physical activities like carrying small children, fishing, hunting, or dancing? Do not include walking.
___ days per week
No moderate physical activities --... ~ Skip to question 5
4. How much time did you spend doing moderate physical activities on one of those days? ___ h, ours per day ___ ,minutes per day
D Oon't know/Not sure
Think about the time you spent walking in the last 7 days. This includes at work and at home, walking to travel fram place to place, and any other walking that you might do solely for recreation, sport, exercise, or leisure.
5. Ouring the last 7 days, on how many days did you walk for at least 10 minutes at a time?
___ days per week
Nowalking __ .. ~~ Skip to question 7
6. How much time did you usually spend walking on one of those days?
___ ,hours per day ___ minutes per day
D Oon't know/Not sure
The last question is about the time you spent sitting on weekdays during the last 7 days. Include time spent at work, at home, while doing course work and during leisure time. This may include time spent sitting at a desk, visiting friends, reading, or sitting or Iying down to watch television.
7. Ouring the last 7 days, how much time did you spend sitting on a week day?
___ hours per day ___ ,minutes per day
D Oon't know/Not sure
8. Compared to the last 7 days, are you usually:
D More active
D Same
D Less active
D Don't know/Not sure
STUDY NO. 1 N 1 U 1 0 1 1 1
<'""crc;jr nrl>< c;b..Dâ .... cr'L..D'"
c;bl>~~ c;crq, 2005
~ C- f~<Jr n,t> < <Jt>C-71., 'li f(h- ""l.,..,D "<JAyne
INT.NO.
Pangnirtung Health Screening 2005
PHYS/CAL ACTIV/TV QUESTIONNA/RE
Interviewer-Completed Questionnaire
Centre for Indigenous People' Nutrition and Environment Macdonald Campus of McGiII University
Completion Date: 05 '_'2005 m d y
Time:_'_ h m
a..àa..VL'-~n" l>'-~..Do.. 7..Do.. l>'ïbc...l>n"dc r'c...~~<l~r nrl>< <ll>c...~Vb ~C~O"''L..D 0.. <lA ~~nc
t>~bc-L ~..)J: <lNr~er<l~PC ~b ""LdC nPdC <lt>c..!--" er~<""J'" ..)nc %...DAc-t>VLer~er~ Cda..er t>'" ..)c..t»er 7er, <In Pt>er<llbnc <lNd(1c Ac-Ler~ ArLrL..)<I?N <lt>c..!--..)<lVC""rLern.!--Ler~, ArLrr<ll..."rc %...DAc-t>~ern. <ccnc A %a..A!--~)nC, <l''''rCjL er <ILL..) AL..."N %err~er, , t>«C .. ...D ... ..." <ILL..." Idl\<lr..)!--I)nC %...DAc-t> ?...,,!--Ier n.<cCAc, A%Ac-~~ern.<cCAc t>«..)erL
A '\I<I~ern. <cCA c,
t>%c-l.?~ La.. ArL ~ I~t>?nr't..;"~rt>~ CLd<lc-L L <f~i'f)n' %-DÂrl>ftrl'L <ccnc Ac-n.<ln.!--n.<I%~)C P~<ftr <f~i'~tr Cda..er t> ... ..."c..t>I)er 7er, <lr?l)er Ac-n.<ln.!--n.<I%I)C AC"'"Ler~ ALAncnJLa..ILC <lrLLn.~ <lerl~)lnCnC"'"l..."nC ALAC)JLa..1clc t>lclLAC)er~ PI\~%Cerl.JL, %...,,~lerl.JL, A %Ac-~ lerl.JL, t>«~erL )bn. <lc-L erl.JL, ArLrr<l)A La..I..)J <lt>c..!--C)nC %...DAc-t>lern.!--Ac lOrL"~t>~L -.!.J",
1. t> ... ..)er 7er, vn<'c- t><' ....">Ac nr~dc <lr?l)nC <lt>c..!--C)nC Ac-n.c..t>"PC? Lder""l, t>ldL6oC)c-n.~c, <I-.!~~~L -.!rc A~~..."er (~p)lrC), %..."Cjer1rC,
D 'bt>i>-L ""r/'bt>i>-L cn<l"f Pt>-.!L "f
t>%('"L I..)J: ArL ~ I~t>?nrc-Irt>~ %...DAc-t>lern.<cCAc nT'dc <f~i'<..JC)nC Cda..er t> ... ~c..t>I)er 7er. <lr?<..)C)er Ib...DA('"t>lert>-.!~ AC"'"Ler~ ALAncnL!--lcI~ Ac.. ""l,Jc <lerl~)lnCnerl~t>..."er <ILL Ld...D ""l,t>-.!L~ I)er t>lclLA..)<I""r)er~ <I!--I~%Cerl.JL,
)bn.<lc-)A La..erl.JL, t>«~erL A '\1 <11er )60 La..I.J", Ar%Cler~ A %~t>n""r'" ....">J. ArLrN)A La..I..."J <lt>c..!--C)nC %...DAc-t>lern.!--Ac lOrL"~t>~L -'!.JL,
('o.
b -y . 'l J A
b d
-0 ·U
ë: 'l
Je .à: v e '"' ...II. J
A V v -0
L e v e '"' v'l v n.. "'\. V
<; ? ."'\. A c-C q rP ~
b:b:- J" 'lA
J AV .'\.. v r ..,.v ..D b <IL
T v e ~ A... A
~T .. ....J ....J-y A... A A a.. rP
110
dld . ~
b<l ,,'"' q baP
n ... 1 A....J J .. • '1 v J A~
q bL . d v -,
-0 V 1 ·vAL v v e <<l'"'\. ~~~ ~ b'" l.U4
....J v b
...... aP r "'\.·1 "'\.<V < y
·A c.. b e ~ v 9 V". b
aP T :;-v l. Â....J<I L"rP "'V<I l.
v b v· c.. ~ • b ~~V "'\....II.? <I-<j< d rP v·
• ..J <1 ~ ",:;-'V '1 'l ~ ... e b
ï!t·...II. aPaPl:( A«
('o.
"b y 1::.. e -, rd ....J S
5 "\.. f "\.. < <l 'l
J 1::..
L J e ;p b " b 1
J A
Ici
L
'-n.. V "\.. d < <l ., J A
1
T V e ~ A... A ,p ...... TT ....J....J A...-y AA ,pa..
o
('o.
b -y ·1 J A
b d
-0 ·U
j V C b
U rP "'\. < <; ?
."'\. A CC q
ri'
cD
L L"'., ... ., J
JA 1::.. v
.'\.. :}- v
b ~L
T V
~ A... A rP ...... TT ....J....J A..." AA rl'a..
110
v C C' V
~ b 4
" b b'.1
nC'V ... dy A~ A J<I
' 1n C J "'\. n A d ...
b 2: ï! d·"'\. aP
-OVA .V~ • < ... ~'1
~~t:: ....JVaP yv< ... e Vnv ......... C 4b 1 ~~
c..L ...... C<l V 9 . C ri' b J .. t,. A
t. T v •• ... V be t, .... f"I V v·V'" c....e ...... < c.... f"I <I.e ....J ... ... ...1\. v
.... <lLC <1 d • .f C' d ri' 4 j
·..J<l T d "-'U -, 1"'d ~ ... 1 e 4 b ..JA-Y.1 t, ...... c..v
aPaP Jy A<<lA
('o.
b:...... n.. V "'\.
~ "b 1
J A
" ;S .:'\ ~ rP '\f :>.. -.q .. ., v cC q
oP
~ b 'l
J A
,...:
b b 'l J"
J A A
L L'" ... "\.. '\..""-v v"'\. "'\. d d< <v v ....... \J'v
~ b
ILl
T v e ~ A... A ..D :::... TT ....J....J A...-y AA rPa..
v a.. dl t,
V A .f "'b
j <1
4
t, d
. ..J ...., 1
"d 4 -0 U
v L f"I dl A J
A '\.. "V
-r f"I dl t,
V L:>. ..r <1 b
d ...1\. J
L:>. V
L "\.. r . ....J <1 u
T f"I dl L
L:>. ..r <1 b
T d ...1\. J
L:>. V
dl
'"' dl d 'l d ......
T J ..J A... L:>. oP
O~ODOD
cxi
