Short-term passive greenspace exposures have little effect on nasal microbiomes: A cross-over exposure study of a Maori cohort.

Indigenous health interventions have emerged in New Zealand aimed at increasing people's interactions with and exposure to macro and microbial diversity. Urban greenspaces provide opportunities for people to gain such exposures. However, the dynamics and pathways of microbial transfer from natural environments onto a person remain poorly understood. Here, we analysed bacterial 16S rRNA amplicons in air samples (n = 7) and pre- and post-exposure nasal samples (n = 238) from 35 participants who had 30-min exposures in an outdoor park. The participants were organised into two groups: over eight days each group had two outdoor park exposures and two indoor office exposures, with a cross-over study design and washout days between exposure days. We investigated the effects of participant group, location (outdoor park vs. indoor office), and exposures (pre vs. post) on the nasal bacterial community composition and three key suspected health-associated bacterial indicators (alpha diversity, generic diversity of Gammaproteobacteria, and read abundances of butyrate-producing bacteria). The participants had distinct nasal bacterial communities, but these communities did not display notable shifts in composition following exposures. The community composition and key health bacterial indicators were stable throughout the trial period, with no clear or consistent effects of group, location, or exposure. We conclude that 30-min exposure periods to urban greenspaces are unlikely to create notable changes in the nasal microbiome of visitors, which contrasts with previous research. Our results suggest that longer exposures or activities that involves closer interaction with microbial rich ecological components (e.g., soil) are required for greenspace exposures to result in noteworthy changes in the nasal microbiome.

Understanding the workforce that supports Maori and Pacific peoples with type 2 diabetes to achieve better health outcomes.

BACKGROUND: Prevalence of Type 2 diabetes mellitus (T2DM) is high among Maori and other Pacific Island peoples in New Zealand. Current health services to address T2DM largely take place in primary healthcare settings and have, overall, failed to address the significant health inequities among Maori and Pacific people with T2DM. Culturally comprehensive T2DM management programmes, aimed at addressing inequities in Maori or Pacific diabetes management and workforce development, are not extensively available in New Zealand. Deliberate strategies to improve cultural safety, such as educating health professionals and fostering culturally safe practices must be priority when funding health services that deliver T2DM prevention programmes. There is a significant workforce of community-based, non-clinical workers in South Auckland delivering diabetes self-management education to Maori and Pacific peoples. There is little information on the perspectives, challenges, effectiveness, and success of dietitians, community health workers and kai manaaki (KM) in delivering these services. This study aimed to understand perspectives and characteristics of KM and other community-based, non-clinical health workers, with a focus on how they supported Maori and Pacific Peoples living with T2DM to achieve better outcomes. METHODS: This qualitative study undertaken was underpinned by the Tangata Hourua research framework. Focus groups with dietitians, community health workers (CHWs) and KM took place in South Auckland, New Zealand. Thematic analysis of the transcripts was used to identify important key themes. RESULTS: Analysis of focus group meetings identified three main themes common across the groups: whakawhanaungatanga (actively building relationships), cultural safety (mana enhancing) and cultural alignment to role, with a further two themes identified only by the KM and CHWs, who both strongly associated a multidisciplinary approach to experiences of feeling un/valued in their roles, when compared with dietitians. Generally, all three groups agreed that their roles required good relationships with the people they were working with and an understanding of the contexts in which Maori and Pacific Peoples with T2DM lived. CONCLUSIONS: Supporting community based, non-clinical workers to build meaningful and culturally safe relationships with Maori and Pacific people has potential to improve diabetes outcomes.

Feasibility and Provisional Efficacy of Embedding High-Intensity Interval Training Into Physical Education Lessons: A Pilot Cluster-Randomized Controlled Trial.

PURPOSE: The aim of this study was to determine the feasibility of generalist school teachers delivering curriculum connected high-intensity interval training in a school's physical education class time. METHOD: Two schools volunteered to participate. A total of 84 students (11.9 [0.5] y, M = 64 and F = 19) volunteered to participate. Four classes from 2 schools were randomized to either intervention (n = 53) or control (n = 31) for one school term (8 wk). Intervention class teachers participated in a 1-day workshop instructing them how to deliver twice weekly, high-intensity interval training sessions. The control classes continued with their usual physical education curriculum. Recruitment, intervention fidelity, and program satisfaction were assessed. Preliminary efficacy (primary outcome cardiorespiratory fitness) was quantified using generalized linear mixed models, expressed as effect size. A range of secondary outcomes was also assessed. RESULTS: The recruitment rate was 88%. About 84% of the sessions were delivered. The heart rate peak over all sessions was 89.6% (13%) of the predicted maximum. The intervention teachers reported high levels of satisfaction. Almost all student participants were positive about participating. No adverse events occurred. The adjusted between-group difference for cardiorespiratory fitness was trivial (effect size 0.02). CONCLUSIONS: This teacher-delivered high-intensity interval training program was feasible and acceptable to both teachers and student participants. It is therefore potentially scalable.

Kaumatua Mana Motuhake Poi: a study protocol for enhancing wellbeing, social connectedness and cultural identity for Maori elders.

BACKGROUND: The Aotearoa New Zealand population is ageing accompanied by health and social challenges including significant inequities that exist between Maori and non-Maori around poor ageing and health. Although historically kaumatua (elder Maori) faced a dominant society that failed to realise their full potential as they age, Maori culture has remained steadfast in upholding elders as cultural/community anchors. Yet, many of today's kaumatua have experienced 'cultural dissonance' as the result of a hegemonic dominant culture subjugating an Indigenous culture, leading to generations of Indigenous peoples compelled or forced to dissociate with their culture. The present research project, Kaumatua Mana Motuhake Poi (KMMP) comprises two interrelated projects that foreground dimensions of wellbeing within a holistic Te Ao Maori (Maori epistemology) view of wellbeing. Project 1 involves a tuakana-teina/peer educator model approach focused on increasing service access and utilisation to support kaumatua with the greatest health and social needs. Project 2 focuses on physical activity and cultural knowledge exchange (including te reo Maori--Maori language) through intergenerational models of learning. METHODS: Both projects have a consistent research design and common set of methods that coalesce around the emphasis on kaupapa kaumatua; research projects led by kaumatua and kaumatua providers that advance better life outcomes for kaumatua and their communities. The research design for each project is a mixed-methods, pre-test and two post-test, staggered design with 2-3 providers receiving the approach first and then 2-3 receiving it on a delayed basis. A pre-test (baseline) of all participants will be completed. The approach will then be implemented with the first providers. There will then be a follow-up data collection for all participants (post-test 1). The second providers will then implement the approach, which will be followed by a final data collection for all participants (post-test 2). DISCUSSION: Two specific outcomes are anticipated from this research; firstly, it is hoped that the research methodology provides a framework for how government agencies, researchers and relevant sector stakeholders can work with Maori communities. Secondly, the two individual projects will each produce a tangible approach that, it is anticipated, will be cost effective in enhancing kaumatua hauora and mana motuhake. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ( ACTRN12620000316909 ). Registered 6 March 2020.

Becoming active: more to exercise than weight loss for indigenous men.

Objective: To understand what motivates sedentary indigenous and ethnic minority men to become more physically active. Design: We use thematic analysis to present data from a qualitative study exploring 23 sedentary indigenous Maori (New Zealand) men's experiences of completing a 12-week exercise intervention to improve their metabolic health. Results: Four themes emerged: The Bros - having fellowship and mutual motivation; Being better informed about exercise; Impacting overall wellbeing; and Disseminating the findings beyond the study Exercise interventions informed by indigenous Maori cultural values and knowledge increased its relevance to their daily lives. The motivation for these indigenous men was more culturally-based external factors than an inherent desire to lose weight. Conclusion: Indigenous and minority men in many developed countries have high morbidity and premature mortality related to sedentary lifestyles. The low uptake of physical activities possibly relates to focusing more on outcomes such as weight loss which lacks cultural relevance. When offering health promotion interventions for marginalized populations these findings highlight the importance of culturally tailoring interventions to the unique sources of motivation for each group to increase activity to improve their efficacy.

Acute Responses to Resistance and High-Intensity Interval Training in Early Adolescents.

Harris, NK, Dulson, DK, Logan, GRM, Warbrick, IB, Merien, FLR, and Lubans, DR. Acute responses to resistance and high-intensity interval training in early adolescents. J Strength Cond Res 31(5): 1177-1186, 2017-The purpose of this study was to compare the acute physiological responses within and between resistance training (RT) and high-intensity interval training (HIIT) matched for time and with comparable effort, in a school setting. Seventeen early adolescents (12.9 ± 0.3 years) performed both RT (2-5 repetitions perceived short of failure at the end of each set) and HIIT (90% of age-predicted maximum heart rate), equated for total work set and recovery period durations comprising of 12 "sets" of 30-second work followed by 30-second recovery (total session time 12 minutes). Variables of interest included oxygen consumption, set and session heart rate (HR), and rate of perceived exertion, and change in salivary cortisol (SC), salivary alpha amylase, and blood lactate (BL) from presession to postsession. Analyses were conducted to determine responses within and between the 2 different protocols. For both RT and HIIT, there were very large increases pretrial to posttrial for SC and BL, and only BL increased greater in HIIT (9.1 ± 2.6 mmol·L) than RT (6.8 ± 3.3 mmol·L). Mean set HR for both RT (170 ± 9.1 b·min) and HIIT (179 ± 5.6 b·min) was at least 85% of HRmax. V[Combining Dot Above]O2 over all 12 sets was greater for HIIT (33.8 ± 5.21 ml·kg·min) than RT (24.9 ± 3.23 ml·kg·min). Brief, repetitive, intermittent forays into high but not supramaximal intensity exercise using RT or HIIT seemed to be a potent physiological stimulus in adolescents.

Provider, father, and bro--Sedentary Maori men and their thoughts on physical activity.

BACKGROUND: Maori (indigenous peoples of New Zealand) men have a disproportionate prevalence of lifestyle-related illnesses and are targeted for national physical activity initiatives. While physical activity impacts on physical and mental health and overall wellbeing, current approaches to health promotion often lack cultural relevance. Having better understanding and incorporating relevant cultural values and motivators into program designs could improve the success of health initiatives for indigenous and minority men. Nevertheless, little is known about Maori men's preferences, attitudes, or perspectives about physical activity, which are often interpreted through a colonized or dominant Western lens. Understanding perspectives of those groups whose values do not align with dominant cultural approaches will better equip health promoters and trainers to develop relevant community initiatives and private programs for indigenous and minority men. METHODS: An indigenous research approach informed a qualitative study with 18 sedentary, 'overweight' Maori men aged 28 to 72 years. From 2014 to 2015 these men participated in three focus group discussions aimed at understanding their views about physical activity and exercise. Data were thematically analysed and interpeted using a Maori worldview. RESULTS: Four key themes were identified - Cameraderie and 'Bro-ship'; Adulthood Distractions and Priorities; Problems with Contemporary Gym Culture; and Provider Orientation. Key motivators for physical activity included a sense of 'brotherhood' in sport and physical activity and accountability to others. Participants reported the need to highlight the value of people and relationships, and having an orientation to the collective to enhance physical activity experiences for Maori men in general. Modern lifestyle distractions (such as being time deficient, and family responsibilities) along with other priorities contributed to difficulties incorporating physical activity into their daily lives. In addition, particular aspects and characteristics of the modern fitness culture and gym environment acted as barriers to adherence to physical activity. CONCLUSIONS: Sedentary Maori men understand the importance of physical activity well, and have a desire to be more active. Nevertheless, they find it difficult to do so while balancing other priorities, especially cultural obligations to community and whanau (immediate and wider family). This research provides valuable insight for those promoting physical activity or designing health initiatives so that they better resonate with indigenous and minority men.

Indigenous Knowledge and the Microbiome-Bridging the Disconnect between Colonized Places, Peoples, and the Unseen Influences That Shape Our Health and Well-Being.

Indigenous Peoples have a rich and long-standing connection with the environments that they descend from-a connection that has informed a deep and multifaceted understanding of the relationship between human well-being and the environment. Through cultural narratives and practices, much of this knowledge has endured despite the ongoing effects that colonization has had on many Indigenous peoples across the world. These narratives and practices, based on observation, experimentation, and practical application over many generations, have the potential to make compelling contributions to our understanding of the environmental microbiome and its relationship to health. Furthermore, the inclusion of Indigenous perspectives regarding the microbiome opens pathways to those who rarely engage with the field and its learnings. Within the scientific community, Indigenous perspectives have not always been acknowledged as valid contributions and are often seen as myth or lacking rigor. Thus, this paper aims to explore an Indigenous perspective of the microbiome as an unseen influence on health and well-being by framing the importance of the natural environment, Indigenous knowledge and leadership, and future research directions that can contribute to this domain. Although the Indigenous perspective in this article reflects the experiences, worldviews, and knowledge of two New Zealand Maori authors, it is hoped that the concepts discussed can relate to Indigenous peoples, and non-Indigenous advocates, globally.

Te Maramataka-An Indigenous System of Attuning with the Environment, and Its Role in Modern Health and Well-Being.

The connection between the natural environment and human health is well documented in Indigenous narratives. The maramataka-a Maori system of observing the relationships between signs, rhythms, and cycles in the environment-is underpinned by generations of Indigenous knowledge, observation, and experimentation. The maramataka enabled Maori and our Pacific relatives to attune with the movements of the environment and ensure activities essential for survival and well-being were conducted at the optimal times. A recent revival of the maramataka in various communities in New Zealand is providing uniquely Indigenous ways to 'reconnect' people, and their health, with the natural environment. In a world where people have become increasingly disconnected from the natural environment, the maramataka offers an alternative to dominant perspectives of health. It also provides a mechanism to enhance the many facets of health through an understanding of the human-ecosystem relationship in a uniquely Indigenous way. This conceptual paper (i) highlights a uniquely Indigenous way of understanding the environment (the maramataka) and its connection to health, (ii) discusses the connections between the maramataka and scientific research on health and the environment, and (iii) introduces current and potential applications of the maramataka in improving health and well-being.

Enhancing health outcomes for Maori elders through an intergenerational cultural exchange and physical activity programme: a cross-sectional baseline study.

Background: The study offers baseline data for a strengths-based approach emphasizing intergenerational cultural knowledge exchange and physical activity developed through a partnership with kaumatua (Maori elders) and kaumatua service providers. The study aims to identify the baseline characteristics, along with correlates of five key outcomes. Methods: The study design is a cross-sectional survey. A total of 75 kaumatua from six providers completed two physical functioning tests and a survey that included dependent variables based in a holistic model of health: health-related quality of life (HRQOL), self-rated health, spirituality, life satisfaction, and loneliness. Results: The findings indicate that there was good reliability and moderate scores on most variables. Specific correlates included the following: (a) HRQOL: emotional support (ß = 0.31), and frequent interaction with a co-participant (ß = 0.25); (b) self-rated health: frequency of moderate exercise (ß = 0.32) and sense of purpose (ß = 0.27); (c) spirituality: sense of purpose (ß = 0.46), not needing additional help with daily tasks (ß = 0.28), and level of confidence with cultural practices (ß = 0.20); (d) life satisfaction: sense of purpose (ß = 0.57), frequency of interaction with a co-participant (ß = -0.30), emotional support (ß = 0.25), and quality of relationship with a co-participant (ß = 0.16); and (e) lower loneliness: emotional support (ß = 0.27), enjoyment interacting with a co-participant (ß = 0.25), sense of purpose (ß = 0.24), not needing additional help with daily tasks (ß = 0.28), and frequency of moderate exercise (ß = 0.18). Conclusion: This study provides the baseline scores and correlates of important social and health outcomes for the He Huarahi Tautoko (Avenue of Support) programme, a strengths-based approach for enhancing cultural connection and physical activity.

Impact of high-intensity interval training including Indigenous narratives on adolescents' mental health: a cluster-randomised controlled trial.

OBJECTIVES: We investigated the efficacy of teacher-delivered high-intensity interval training (HIIT) with Indigenous narrative options on the mental health of school students in low-mid socioeconomic areas, compared to standard curriculum physical education practice. METHODS: A cluster-randomised controlled trial was conducted in eight schools (N=368, age range 11-13 years) over 16 weeks. The primary outcome was the Strengths and Difficulties Questionnaire (SDQ) score. Generalised linear mixed models, controlling for the SDQ at baseline were applied, expressed as ß, 95% confidence intervals, standardised effect, and p-value. Focus groups elicited experiences with participating in and delivering the intervention. RESULTS: There were no clear effects for SDQ total score (ß -0.15, CI -0.98 - 0.67, SE 0.42, p=0.714). Teachers did not deliver the Indigenous narrative options consistently owing to the perceived preparation needed and lack of confidence. CONCLUSIONS: HIIT delivered in this manner had no effect on self-perceived psychological difficulty or mental wellbeing in a cohort of young adolescents. IMPLICATIONS FOR PUBLIC HEALTH: Future research should continue to explore opportunities to improve mental wellbeing via physical activity, but HIIT should not be implemented as a universal intervention for mental health gains alone. Teachers need more support to utilise Indigenous narratives as part of HIIT delivery.

Cultural efficacy predicts body satisfaction for Maori.

This paper examines the relationship between body mass index (BMI), self-esteem and self-reported confidence and capability in expressing oneself culturally as Maori (cultural efficacy) for 5,470 Maori who participated in Te Rangahau o Te Tuakiri Maori me Nga Waiaro a-Putea | The Maori Identity and Financial Attitudes Study (MIFAS) in 2017. Adjusting for demographics, self-reported health, education and socio-economic status, we found that a higher BMI was associated with lower body satisfaction and self-esteem. However, higher scores on cultural efficacy were associated with higher levels of body satisfaction and self-esteem for respondents. Furthermore, the negative association between BMI and both body satisfaction and self-esteem was weaker for those with higher cultural efficacy. This held for BMI scores of 25, 30, and 35+. While our data suggest higher cultural efficacy may directly or interactively shield Maori from developing lowered self-esteem typically associated with higher BMI in Western populations, further research, using more comprehensive measures of body satisfaction should explore the extent to which Maori may find the Western "thin ideal" personally desirable for their own bodies.

From gorse to ngahere: an emerging allegory for decolonising the New Zealand health system.

Prior to colonisation, Maori had a well-developed holistic health system based on maintaining balance between people, place and spirit. The colonial imposition of British economic, religious, educational, legal, health and governance, through warfare, immigration, legislation and social coercion had a devastating effect on Maori health outcomes. With the release of the WAI 2575 Waitangi Tribunal report exposing the failings of our health system in relation to Maori health, the need to decolonise our health system becomes more pressing. A key difficulty in this work is the poverty of transformative language, concepts and frameworks in our workforce. This paper is the product of an anti-racism think tank that occurred in April 2019. While working through a system change analysis on our colonial health system, Maori and Tauiwi activists and scholars created an allegory-from gorse to ngahere. The allegory depicts the ongoing impact of the colonial health system as represented by gorse, and the possibilities of a decolonised health system represented by ngahere-a self-sustaining and flourishing native forest. Racism has a geographic specificity. The allegory we developed is a mechanism for conceptualising decolonisation for the context of Aotearoa. It serves to reinforce the different roles and responsibilities of the descendants of the colonisers and the colonised in the pursuit of decolonisation.