Cardiovascular disease (CVD) continues to be the leading cause of death among Aboriginal Australians, with deaths occurring at a younger age than in other Australians.1 While a multitude of factors underlie this disparity, the well-documented health service gap for Indigenous compared with non-Indigenous Australians is a significant contributing factor.2 Cardiac rehabilitation is a clear example. Although a variety of models exist,3 Aboriginal people are underrepresented in cardiac rehabilitation programs4 and therefore forego the well-documented benefits, including reduced all-cause mortality,5,6 reduced recurrent cardiac events7 and improved quality of life.8
To help address this service gap, a cardiac rehabilitation program was established in a metropolitan Aboriginal Medical Service (AMS) and its uptake, impact on health management behaviour and cardiovascular risk factors were documented.
Focus groups were held with Aboriginal health professionals and community members to ensure the program met their needs and expectations. The latter group were specifically questioned about their preferred setting for cardiac rehabilitation.
A cardiac rehabilitation program was established under the auspices of Derbarl Yerrigan Health Service (DYHS) (a community controlled AMS) and conducted onsite to provide a culturally secure environment for the provision of exercise and education to address cardiovascular health. The name of the program, 'Heart Health - for our people, by our people' (Heart Health) reflected ownership byDYHSand the broader Aboriginal community.
Participants enrolling in Heart Health were invited to take part in a formal research project to evaluate the program and these participants provided written informed consent. The study was approved by the Human Research Ethics Committees of Curtin University and Royal Perth Hospital and The Western Australian Aboriginal Health Ethics and Information Committee.
Heart Health included core components for CVD management; assessment and reassessment, provision of health information and an individualised program.9 Referrals occurred via several sources including a DYHS physician, a physician from another medical practice, from tertiary hospitals or by self referral.
At enrolment, participants underwent a baseline health and fitness evaluation including height and weight to derive body mass index (BMI), a 6-min walk test (6MWT), resting seated blood pressure and waist girth. A subgroup of participants had a follow up assessment after 8 weeks of sessions.
Heart Health was conducted between 9 a.m. and 1 p.m. on Thursdays to meet community preference for a midweek program, which was less likely to conflict with travel to attend funerals and cultural or family events. Attendance during program hours was flexible. Participants had blood pressure, pulse and bodyweight assessed at each session. Point-of-care testing was employed to monitor blood sugar levels (BSL) by participants with type 2 diabetes, with staffguiding technique when necessary. Feedback on measures was provided to participants and used as teachable moments to address lifestyle management, the importance of medication adherence and regular surveillance of glycaemic control and lipid profiles.
The program was easily accessible by public transport and DYHS provided transport for people who would not otherwise have been able to attend.
Stationary cycling and dumbbell exercises were prescribed and supervised by an exercise physiologist, and an outdoor walking group was implemented. Participants were also given guidance to increase home-based physical activity to accumulate at least 150 min of moderate physical activity per week. Motivational strategies were employed to encourage participants to increase their activity. For example, participants recorded kilometres cycled and tracked their journey on a large wall-mounted map of Western Australia, with the goal of riding from Perth to Broome (~2500 km). …