Cardiovascular Disease Prevention In Australian High School Students

Introduction

The program is a one-year comprehensive school-based initiative for Cardiovascular Disease prevention and control via reducing the risk factors and harmful behaviours of CVD in Australian high school students. Physical activity reduces the potential of experiencing a major coronary event as it targets numerous CVD risk factors such as hypertension, hypercholesterolemia, obesity and sedentary lifestyle behaviours. (Twist, Kemper, Van Mechelen 2002).

The aim of this program is to increase physical activity in school children as well as inform about the harmful behaviours, which contribute to the prevalence of CVD in Australia. This is achieved through group-based sessions after school, which involves a physical component of competition based games as well as an educational awareness program outlining the dangers of inactive lifestyle behaviours. Physical inactivity is the fourth leading cause of death due to non-communicable disease worldwide and contributes to over three million preventable deaths annually. (Australian Department of Health).

Furthermore, Coronary heart disease is the leading specific cause of total burden of disease in Australia, accounting for 7.7% of the total disease burden (Australian Institute of Health and Welfare). It affects about 1 in 30 adults (3.3%, 645,000 people), and 1 in 6 people aged 75 and over (Australian Institute of Health). By targeting youth as opposed to adults, the program will ensure preventative measures are put in place to decrease future incidents, prevalence and case-fatality of CVD.

Needs Assessment

Childhood obesity in Australia and the theory of Persistence Early preventative measures in children are a necessity in order to delay or potentially eradicate the onset of CVD. The Department of health states that 28 percent of Australian children are considered obese and possess a 25-50 percent probability of sustaining obesity once they become adults (Health Direct Australia 2018). In addition to this (Singh et al 2008), habituation of lifestyle factors is investigated where the persistence of risk factors from childhood into adulthood are clearly outlined as a constant issue, highlighting the increased risk for obese children in comparison to non-obese groups.

This review found that obese children are twice as likely to remain obese in comparison to normal-weight children and ultimately possess an increased risk for the development of CVD (Singh et al 2008). The study (Freedman et al 2007) analysed children/adolescents from 5-17 years old and found that as BMI-for-age increased the amount of children with two or more cardiovascular factors increased simultaneously from 5 to 59 percent. Additional data demonstrated that obese adolescents with a BMI greater than 85th percentile would present at least 2 cardiovascular disease risk factors (Cook et al 2003).

Risk factors

Risk factors for childhood obesity leading to development of CVD are environmental, social and behavioural influential components. The study (Maes, Neale & Eaves 1997) found that the correlation of BMI for monozygotic twins is 0.74, meaning a certain portion of childhood obesity cannot be changed however demonstrated increased importance on other preventative measures. Parental environmental influences are associated with increased childhood obesity and risk factors include socioeconomic status, nutrition and physical activity.

The review (Davis et al 2007) highlighted association between overweight children and sedentary behaviour, ‘eating out’ frequently, irregular sleeping patterns, the absence of breakfast, unregulated screen time and the absence of portion control. This demonstrates that a health care program providing education for both the children and parents is mandatory to achieve efficacy.

Health care programs and the future

Current healthcare programs and initiatives attempt to target children and parents individually, in aim to reduce persistence of obesity and ultimately CVD occurrence. Initiatives include ‘Live Lighter’ a program that educates children about healthy eating and ‘Parent’s voice’ an online group for parents seeking education regarding improvement of a child’s nutrition and activity environment (Livelighter 2018) (Parents Voice 2018). Despite these programs displaying some reputable results an additional program targeting both parents and children simultaneously with a direct focus on CVD is essential in order to prevent occurrence.

Proposed Planning Scheme

• Educate young people

With young people spending most of their time attending school the most useful way to target and prevent CVD from a young age is the development of programs within schools aimed at intervention and prevention. Although the majority of young people are free of CVD, they are not free of CVD risk, especially lifestyle factors such as poor exercise and dietary habits (Chung, Touloumtzis & Gooding 2015). Thus emphasis should not be placed on just the physical aspects of the program but also the theoretical as this allows students to develop the knowledge, attitudes and behavioural skills needed to establish and maintain a healthy eating and physically active lifestyle (International Journal of Obesity 1999).

• Encourage supportive parental environments

Although schools play a large part in educating children, it has been proven that positive home environments where young people felt supported was associated with reduced CVD risk levels in adulthood (Chung, Touloumtzis & Gooding 2015). With increased transport and technology, many parents have chosen to use buses as the main form of transportation of their children to and from school, rather than allowing them to walk (Hesketh et). Another barrier for physical participation was the lack of time parents had to enrol their children in an organised sport (Hesketh et al 2005).

Thus, the after-school programs ran by this program overcome this obstacle, as children are able to participate in a range of different activities. In relation to this sessions directed at parents inform them about strategies that can be put into place to reduce the risk of CVD. These include not restricting the amount of foods children ate during meals, to promote self regulation which fosters healthy foods practices (Golan & Crow 2012), and showing the importance of parental support for youth physical activity, as it has direct influences on self-efficacy (Trost et al 2003).

• Improve obesity rates in young people

Obesity especially the visceral type is a known factor for the development of CVD, thus weight loss through healthier eating and physical activity of young people improves insulin sensitivity and in turn reduces the risk of CVD (Sowers 2003). By recording the blood pressure of students before and after taking part in the program, findings can be compared to see if there is a direct link between obesity and CVD, as obesity is seen to be a cause of high blood pressure (Jeffery 1992). The physical activity sessions held after school have a main goal of decreasing sedentary behaviours and reducing weight status, which in turn lower the rates of obesity in young people (International Journal of Obesity 2009).

• Create awareness and inform the public

The school based program used within this program not only directly engages young people in health behaviour change, but allows for health care services to actively support the efforts given by the program and in turn widen community based initiatives (Chung, Touloumtzis & Gooding 2015). Furthermore with technological support, health behaviours in young people can be altered as the media reduces the amount of fast food advertisements online and on TV, and advertising more healthier and active lifestyles (Chung, Touloumtzis & Gooding 2015).

Selected Strategies

Promoting physical activity helps establish basic exercise principles and nutrition (Clinch, 2010), however, simply providing education about risk factors and principles is useless without providing an avenue in which they can combat these behaviours. Childhood is a sensitive period within an individual’s life, which consists of dynamic changes in development, determining whether healthy or unhealthy behaviours are adopted (Faigenbaum & Myer 2012). The implementation of a health informational seminar monthly combats objective one as it provides knowledge on physical activity and nutritional requirements prior to the commencement of the program.

This seminar creates a positive environment serving as an educational tool to inform children of healthy behaviours, which can impact their future lifestyles. Each child will fill out a survey to be compared to in post stages– allowing the opportunity to develop the ‘competence and confidence to be physically active later in life’ (Faigenbaum & Myer 2012) and thus, emphasising that education can prove highly beneficial to prevention of future life diseases. Teachers and parents are highly familiar with the children's lifestyle habits and these connections are utilised to provide a supportive environment.

Role modelling by parents have a direct effect on children’s physical participation whilst also affecting their competence (Bois et al 2005). Parental influence aims to combat objective two identifying the strong relationship between role models and competence; using these influences improves the likelihood to uptake the recommended exercise behaviours. This involvement builds awareness, allowing self-reflection by the children and parents on their personal participation to combat the technicalities of creating awareness - aiming to address objective four. Specific tasks are implemented (journal and parental involvements) to emphasis the influence parents have on their children’s physical participation, creating an even bigger support network for all children and reflection on the older population who have an increased risk of CVD.

The App in conjunction with the journal produces a time component of the physical activity undertaken providing information on how often they participate and compares to the physical activity guidelines (150-300 minutes of moderate intensity weekly) scoring them on a week-to-week basis, and challenging them to do better allowing an evaluation to be drawn from. The introduction of sporting groups weekly aiming to discuss and complete exercise based programs will engage regular interaction through physical activity and provide support to overcome sedentary lifestyle behaviours. These strategies combine to help improve obesity rates, directly impacting objective three allowing a supportive environment to participate in physical activity with the hope of reducing their risks of future lifestyle diseases.

Evaluation Plan

The evaluation of the strategies is necessary in assessing the effectiveness of the program to prevent obesity within young individuals potentially decreasing the risk factors for CVD within the future (Rowley et al 2000). There will be physical tests throughout (BMI, weight, BP), as well as thoroughly documented information along the way. According to Bauman, an effective way to observe pre and post test activity levels is through the NSW Child Health Survey (Bauman et al 2010). Questions as simple as “How often do you engage in physical activity”, allows professionals to comprehend and compare accordingly the physical capabilities of the individuals physical participation, assuming all are truthful. Every child who attends the seminars are asked to complete the evaluative survey, which will be measured to the post program results to assess in relation to the physical activity guideline targets.

Physical participation percentages will be expressed through the APP and documented journals, which provide detail of the average score of completion the guidelines and hours over the time period individually. This is compared to the expected hours of completion equating to an overall attendance percentage. The outcome will be expressed by analysing individual exercise behaviour and whether a change in daily activities or weekly regimen is evident within the documentation (Peiris et al 2012). It is assumed through attendance the participants will be achieving the physical activity guidelines and if these achieve maximum growth the objectives have potentially been achieved - being achieved through persistence of exercise behaviours.