Build it and they will come: outcomes from a successful cardiac rehabilitation program at an Aboriginal Medical Service
Lyn Dimer A , Ted Dowling B C , Jane Jones B , Craig Cheetham D E , Tyra Thomas A F , Julie Smith A , Alexandra McManus G and Andrew J. Maiorana H I JA National Heart Foundation, 334 Rokeby Road, Subiaco, WA 6008, Australia.
B Derbarl Yerrigan Health Service, 156 Wittenoom Street, East Perth, WA 6004, Australia.
C Cardiology Department, Royal Perth Hospital, Box X2213 GPO, Perth, WA 6847, Australia.
D Cardiovascular Prevention and Rehabilitation Western Australia, PO Box 654, Scarborough, WA 6922, Australia.
E School of Exercise, Sport Science and Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
F Child and Adolescent Health Service, 240 Hardey Road, Belmont, WA 6104, Australia.
G Centre of Excellence for Science, Seafood and Health and Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
H School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
I Advanced Heart Failure and Cardiac Transplant Service, Royal Perth Hospital, Box X2213 GPO, Perth, WA 6847, Australia.
J Corresponding author. Email: a.maiorana@curtin.edu.au
Submitted: 5 December 2011 Accepted: 28 May 2012 Published: 21 December 2012
Journal Compilation © AHHA 2013
Abstract
Objective. Cardiovascular disease (CVD) is the leading disease burden in Aboriginal Australians, but culturally appropriate cardiac rehabilitation programs are lacking. We evaluated the uptake and effects on lifestyle, and cardiovascular risk factors, of cardiac rehabilitation at an Aboriginal Medical Service (AMS).
Methods. The program involved weekly exercise and education sessions (through ‘yarning’) for Aboriginal people with or at risk of CVD. Participants’ perceptions of the program and the impact on risk factors were evaluated following 8 weeks of attendance.
Results. In twenty-eight participants (20 females) who completed 8 weeks of sessions, body mass index (34.0 ± 5.1 v. 33.3 ± 5.2 kg m–2; P < 0.05), waist girth (113 ± 14 v. 109 ± 13 cm; P < 0.01) and blood pressure (135/78 ± 20/12 v. 120/72 ± 16/5 mmHg; P < 0.05) decreased and 6- min walk distance increased (296 ± 115 v. 345 ± 135 m; P < 0.01). ‘Yarning’ helped identify and address a range of chronic health issues including medication compliance, risk factor review and chest pain management.
Conclusions. AMS-based cardiac rehabilitation was well attended, and improved cardiovascular risk factors and health management. An AMS is an ideal location for managing cardiovascular health and provides a setting conducive to addressing a broad range of chronic conditions.
What is known about the topic? Cardiovascular disease is the leading cause of morbidity and mortality in Aboriginal Australians, but less than 5% of eligible Aboriginal people attend hospital-based cardiac rehabilitation.
What does this paper add? This is the first study to describe a culturally appropriate cardiac rehabilitation program conducted in a metropolitan Aboriginal Medical Service. It provides a detailed account of the program’s components and its effects on physical and psychosocial determinants of cardiovascular health in participants.
What are the implications for practitioners? Health management programs similar to the one evaluated in this study could be developed to suit the specific needs of other Indigenous communities around Australia to address a range of chronic conditions.
References
[1] Australian Institute of Health and Welfare. Cardiovascular disease: Australian facts 2011. Cardiovascular disease series. Cat. no. CVD 53. Canberra: AIHW; 2011.[2] Cunningham J, Cass A, Arnold P. Bridging the treatment gap for Indigenous Australians. Med J Aust 2005; 182 505–6.
| 15896177PubMed |
[3] Briffa T, Kinsman L, Maiorana A, Zecchin R, Redfern J, Davidson P, et al An integrated and coordinated approach to preventing recurrent coronary heart disease events in Australia. Med J Aust 2009; 190 683–6.
| 19527203PubMed |
[4] Shepherd F, Battye K, Chalmers E. Improving access to cardiac rehabilitation for remote Indigenous clients. Aust N Z J Public Health 2003; 27 632–6.
| Improving access to cardiac rehabilitation for remote Indigenous clients.Crossref | GoogleScholarGoogle Scholar | 14723412PubMed |
[5] Clark A, Hartling L, Vandermeer B, McAlister F. Secondary prevention programs for patients with coronary artery disease: A meta-analysis of randomized control trials. Ann Intern Med 2005; 143 659–72.
| 16263889PubMed |
[6] Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2004; CD001800
[7] Chow C, Jolly S, Rao-Melacini P, Fox K, Anand S, Yusuf S. Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes. Circulation 2010; 121 750–8.
| Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes.Crossref | GoogleScholarGoogle Scholar | 20124123PubMed |
[8] Oldridge N, Guyatt G, Jones N, Crowe J, Singer J, Feeny D, et al Effects on quality of life with comprehensive rehabilitation after acute myocardial infarction. Am J Cardiol 1991; 67 1084–9.
| Effects on quality of life with comprehensive rehabilitation after acute myocardial infarction.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3M3itFSgtg%3D%3D&md5=f520fd91f69528414d3d498b01e07e42CAS | 2024598PubMed |
[9] Redfern J, Maiorana A, Neubeck L, Clark A, Briffa T. Achieving coordinated secondary prevention of coronary heart disease for all in need (SPAN). Int J Cardiol 2011; 146 1–3.
| Achieving coordinated secondary prevention of coronary heart disease for all in need (SPAN).Crossref | GoogleScholarGoogle Scholar | 20826024PubMed |
[10] Bessarab D, Ng’andu B. Yarning about yarning as a legitimate method in Indigenous research. Int J Critical Indigenous Studies 2010; 3 37–50.
[11] Begley L, Harald P. ‘Yarning for better health’ improving the health of an Aboriginal and Torres Strait Islander population. Aust Fam Physician 2005; 34 27–9.
| 15727354PubMed |
[12] Daniel M, Lekkas P, Cargo M. Environment and cardiometabolic diseases in Aboriginal populations. Heart Lung Circ 2010; 19 306–15.
| Environment and cardiometabolic diseases in Aboriginal populations.Crossref | GoogleScholarGoogle Scholar | 20356789PubMed |
[13] National Health and Medical Research Council (NHMRC). Strengthening cardiac rehabilitation and secondary prevention for Aboriginal and Torres Strait Islander peoples: a guide for health professionals. Canberra: NHMRC; 2005.
[14] DiGiacomo M, Thompson S, Smith J, Taylor K, Dimer L, Ali M, et al ‘I don’t know why they don’t come’: Barriers to participation in cardiac rehabilitation. Aust Health Rev 2010; 34 452–7.
| ‘I don’t know why they don’t come’: Barriers to participation in cardiac rehabilitation.Crossref | GoogleScholarGoogle Scholar | 21108907PubMed |
[15] Brown A, Blashki G. Indigenous male disadvantage - linking the heart and mind. Aust Fam Phys 2005; 34 813–9.
[16] Verrill D, Barton C, Beasley W, Lippard M, King C. Six-minute walk performance and quality of life comparisons in North Carolina cardiac rehabilitation programs. Heart Lung 2003; 32 41–51.
| Six-minute walk performance and quality of life comparisons in North Carolina cardiac rehabilitation programs.Crossref | GoogleScholarGoogle Scholar | 12571547PubMed |
[17] Zullo M, Dolansky M, Jackson L. Cardiac rehabilitation, health behaviors, and body mass index. J Cardiopulm Rehabil 2010; 30 28–34.
[18] Jolly K, Taylor R, Lip G, Stevens A. Home-based cardiac rehabilitation compared with centre-based rehabilitation and usual care: A systematic review and meta-analysis. Int J Cardiol 2006; 111 343–51.
| Home-based cardiac rehabilitation compared with centre-based rehabilitation and usual care: A systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 16316695PubMed |
[19] Sibthorpe B, Bailie R, Brady M, Ball S, Sumner-Dodd P, Hall W. The demise of a planned randomised controlled trial in an urban Aboriginal Medical Service. Med J Aust 2002; 176 273–6.
| 11999260PubMed |
