Rona Macniven

Issue Addressed: Young strong and deadly is a health education and exercise program for Aboriginal young people aged 12–16 years in Western Sydney. The 14‐week program comprises paid gym memberships, guided gym sessions, transport provision, nutrition education and is led by Aboriginal qualified professionals. This mixed method process evaluation examined program delivery and implementation factors. Methods: Qualitative yarning participants were 19 program participants, six program staff and nine family member stakeholder participants post‐program and/or at 3‐ and 6‐months follow‐up. Quantitative data were collected through a program checklist tool that measured adherence and fidelity through observation and attendance, gym records and staff member characteristics. Results: In Cohort 1 (September–December 2023), 27 sessions were delivered over 14 weeks and an average of 90% ( n = 19) of sessions were attended by 24/31 program completers. In Cohort 2 (May–August 2024), 26 sessions were delivered over 13 weeks and an average of 77% ( n = 20) of sessions were attended by 13/18 program completers. Five themes reflect participant program acceptance and are described: Design and development of the Program; Program benefits and positive impact observed; Challenges and Barriers Experienced by the Program; Participant Motivations and Experiences; Future Directions and Recommendations for the Program. Conclusions: Young strong and deadly has demonstrated feasibility and acceptability among Aboriginal young people and their families. So What?: An assertive and culturally appropriate program that is purposeful and meaningful can be successfully implemented and improve the health and wellbeing of young Aboriginal people.

Background: Prevention of falls aids healthy ageing, but there are few Aboriginal-led and designed programs. Objectives: This study aimed to evaluate the effect of Ironbark, an Aboriginal co-designed fall prevention program, on functional mobility, a key indicator of falls. Methods: This controlled pre-post study was conducted in organisations delivering services to Aboriginal people aged 45 years and older in New South Wales and Western Australia. A co-designed fall prevention program incorporating exercises and yarning circles targeting fall risk factors (‘Ironbark Standing Strong and Tall’) was compared to a social program (‘Ironbark Healthy Community’). Data were collected at baseline and after 12 months of follow-up. Results: The ‘Ironbark Standing Strong and Tall’ program was delivered at 16 sites and the ‘Healthy Community’ program at three. Due to lower recruitment than anticipated, combined analysis was not possible. There were significant improvements in the ‘Ironbark Standing Strong and Tall’ participants for the primary outcome of functional mobility (Short Performance Physical Battery; a change of 0.8 points, 95% CI: 0.4–1.1), reductions in stepping times, improvements in leg stance and increased incidental and planned exercise. There were no significant changes in falls, health-related quality of life (HRQoL) or psychological distress. Participants in the ‘Healthy Community’ sites had no change in functional mobility but saw declines in HRQoL, physical activity and stepping time. Conclusions: A co-designed and delivered program for older Aboriginal people, implemented in community settings aligned with stated priorities of Aboriginal older people, improved functional mobility.

This Handbook has covered the expansive territory encompassed by physical activity research, policy, and practice. This epilogue poses a few final thoughts and overarching future directions. First, physical activity is much more than “exercise”, and second, physical activity promotion initiatives and programmes often happen outside the health sector, not just within it. This implies a whole-of-government, whole-of-society approach with policymakers working across multiple government departments to increase physical activity. For researchers a broad range of methods of inquiry are needed to understand how to encourage populations to be more active.

Physical activity and health is a wide-reaching field that is relevant to exercise and sport science, public health, urban and transport planning, occupational

First Nations, or Indigenous, peoples are a diverse group of hundreds of millions of tribal peoples globally. First Nations perspectives of health differ from biomedical models and include the interconnectedness of Country, people, and culture, requiring a holistic approach that integrates traditional knowledges and practices. Traditional physical activity practices are evident in First Nations cultures, some with localised cultural significance. This chapter will describe data on First Nations physical activity rates and the unique physical activity perceptions and influences for First Nations peoples and will provide evidence and examples of successful physical activity initiatives for First Nations peoples. It will conclude with a commentary on research gaps and future directions, offering practical recommendations for researchers, practitioners, and policymakers.

In addition to effects on the primary prevention of disease, physical activity has benefits in the management and treatment of many chronic and important conditions. These include cardiovascular disease, diabetes, and the metabolic syndrome, musculoskeletal disorders, as well as many neuropsychiatric conditions, other endocrine conditions, and cancers. Best practice is where clinical guidelines specify the types of physical activity recommended for each condition, cognisant of disease severity and an individual’s capacity to be active. Many conditions benefit from both aerobic (large muscle, movement-related) activities and resistance exercises. Including physical activity advice into clinical management involves the whole management team, including medical, allied health, and specialist exercise professionals. Physical activity may be recommended in hospital or primary care settings, or in disease-specific programmes delivered at home, online, or through structured or unstructured exercise programmes in the community.

Background: Falls are a leading cause of injury and loss of independence among older Aboriginal people. The Ironbark program is a culturally co-designed, community-based fall prevention initiative, incorporating exercises and Yarning circles, a culturally grounded form of group discussion. This paper presents a process evaluation of the program, examining fidelity and key factors influencing implementation across settings. Methods: Sixteen sites across two Australian states implemented the Ironbark Standing Strong and Tall program. Process data were collected from 15 sites through structured session observations and semi-structured interviews with exercise facilitators. Fidelity and dose were assessed quantitatively, with adherence scored using a summative checklist score. Qualitative data were thematically analysed and mapped onto the Consolidated Framework for Implementation Research (CFIR). Results: The program was delivered with high fidelity to 117 participants with median adherence scores consistently above 80%. Sessions were implemented as planned, with strong participant engagement in both exercise and Yarning components. Key facilitators included Aboriginal leadership, trusted site managers, program flexibility and supportive service structures. Challenges included managing varying physical abilities, maintaining engagement over time and external disruptions (e.g. Coronavirus -19 pandemic, weather). Content repetition was noted as a barrier to sustained attendance by participants in later stages. Facilitators recommended additional training, mid-program assessments and access to site-collected data. Sustainability was linked to workforce capacity and securing ongoing funding, particularly to support Aboriginal staff and transport. Conclusion: This process evaluation indicated that a culturally-relevant fall prevention program for older Aboriginal people can be implemented with fidelity across community settings. Findings provide practical guidance for exercise facilitators and on sustaining and expanding the Ironbark program and inform broader efforts to embed culturally safe, community-led health programs in routine practice.

Introduction: Despite reductions in tobacco smoking among Aboriginal and Torres Strait Islander peoples since 2004, particularly among youth, smoking remains elevated in Indigenous communities —highlighting the importance of understanding why some Aboriginal and Torres Strait Islander people never take up smoking. Methods: Taking a strength-based approach and using data from 473 Aboriginal and Torres Strait Islander youth aged 16–24 years joining the Next Generation Youth Wellbeing Study (Western and Central Australia, New South Wales), 2018–2020, age-, sex-, and family-adjusted prevalence ratios (PRs) for never-smoking relative to sociodemographic, health, social, and other factors across socioecological levels were estimated through Poisson regression. Results: Overall, 45% of participants had never smoked tobacco; 31% reported current daily/weekly/monthly smoking, indicating a normative shift. Among those who ever smoked, mean initiation age was 15. Never-smoking was greater with: younger age [16–17-years (PR = 1.9; 95% Confidence Interval = 1.5–2.5), 18–20 (1.3;1.0–1.8)]; completing ≥Year 10 (1.8;1.1–3.0); no interaction with (1.9;1.5–2.5) or being charged by police (2.3;1.5–3.3); never being imprisoned (2.5;1.2–4.8); not having friends imprisoned (1.7;1.3–2.2); having non-smoker friends (1.8;1.4–2.2); never vaping (5.7;3.2–10.1) or smoking marijuana (7.9;4.9–12.8), never having tried alcohol (2.4;2.0–3.0); higher physical activity (1.4;1.1–1.7); and lower psychological distress (1.3;1.1–1.6), never being diagnosed with depression (1.5;1.1–2.1) or anxiety (1.7;1.2–2.4), and having “good-to-excellent” perceived health (1.5;1.1–2.1), compared with not having these attributes. Conclusions: These findings highlight the importance of strengthening family, community, and social environments that protect against smoking initiation and support smoking cessation, and call for sustained structural and policy reforms to address systemic drivers of tobacco use. Implications: Preventing smoking uptake and long-term use among Aboriginal and Torres Strait Islander youth will continue to reinforce a tobacco-free norm and improve long-term tobacco-related outcomes for the total Indigenous population. Ongoing investment in tobacco control and effective smoking cessation initiatives and new initiatives that build on the strengths of Aboriginal and Torres Strait Islander youth are warranted. Tailored approaches should enable protective factors at population-, community-, and individual-levels. Initiatives may include programs to delay initiation, further promotion of youth-friendly, culturally appropriate cessation support, and a holistic focus on wellbeing embedded in Aboriginal and Torres Strait Islander culture.

For Aboriginal and Torres Strait Islander peoples, health is a holistic concept; encompassing physical, social, emotional, and cultural wellbeing, reinforced through connection to Country, language...