Table 1.

By targeted setting, interventions reporting on physical activity among Native youth (n=20 unique interventions; 76 articles)

Intervention Target Age Group Geographic Setting Sample Size	Brief Description
Childcare-based
The Child Health Initiative for Lifelong Eating and Exercise (CHILE)30,45,86,87	Used a socio-ecological approach to design an intervention including classroom curriculum, teacher and food service training, family engagement, grocery store participation, and health care provider support. Reported on lessons learned and concluded Head Start could play an important role in improving physical activity among preschool children.
Preschool (Head Start)
Southwest (6 rural Pueblos, New Mexico) 1879
Church-based
Native Proverbs 31 Health Project39	Conducted formative research to develop weekly classes during a 4-month period in 4 churches (2 primary churches and 2 delayed intervention churches) that were led by community lay health educators. Reported churches were receptive to the program including hosting a walking club.
Multiple Age Ranges (Adult Women and Girls > 12 years old)
Southeast (Robeson County, North Carolina, homeland of the Lumbee Tribe of North Carolina)
4 Lumbee churches (64 women and 11 girls in 2 primary intervention churches; 82 women and 8 girls in 2 delayed intervention churches)
Family-based
Healthy Children, Strong Families18,31,68,88–93	Conducted a randomized controlled trial of a healthy lifestyles intervention. Reported on how the community advisory boards established in each of the participating communities were highly effective at improving community environments including increasing people’s choices for engaging in physical activity.
Preschool (2 to 5 years)
Midwest (four Wisconsin tribes)
120 families
Healthy Hearts Across Generations35	Conducted a randomized controlled trial designed to evaluate a culturally appropriate cardiovascular disease risk prevention program for American Indian parents that included motivational interviewing counseling followed by personal coach contacts and family life-skills classes. Noted environmental interventions such as footpaths are being discussed with the community for future planning efforts.
Multiple (child closet to 5 years if multiple minors)
Pacific Northwest
135
Obesity Prevention Plus Parenting Support36	Randomly assigned mothers to a 16-week intervention that was delivered one-on-one in homes by an Indigenous peer educator. Reported a trend towards significance for weight-for-height z scores increasing among the intervention group.
Early Infancy (ages of 9 months and 3 years)
Northeast (St. Regis Mohawk community of Akwesasne located along the St. Lawrence River in northern New York State and Ontario and Quebec, Canada)
43
Prevention of Toddler Obesity and Teeth Health Study29	Conducted a randomized controlled trial designed to prevent obesity beginning at birth in American Indian children that was designed to promote breastfeeding, reduce sugar-sweetened beverage consumption, appropriately time the introduction of healthy solid foods, and counsel parents to reduce sedentary lifestyles in their children. Reported strengths and weaknesses of study design.
Early Infancy (birth cohort followed for two years)
Pacific Northwest (five tribes who are members of the Northwest Portland Area Indian Health Board (Idaho, Oregon and Washington))
577
The Indian Family Wellness Project38,94	Described four tribal participatory research mechanisms with applicability to family-centered prevention research. Reported high participation and retention rates in research component of project.
Preschool (Head Start)
Pacific Northwest (a tribe)
Not specifically reported; noted more than 80% of enrolled families at four tribal Head Start sites participated
The Toddler Overweight and Tooth Decay Prevention Study34	Tested the feasibility of community-tailored intervention using trained community health workers to deliver a family intervention through home visits. Reported family plus community-wide intervention may help attenuate body mass index rise in American Indian toddlers.
Early Infancy (birth cohort followed for two years)
Pacific Northwest (three tribes who are members of the Northwest Portland Area Indian Health Board)
178
School-based
Bright Start20,95–100	Conducted group-randomized trial that aimed to increase physical activity at school to at least 60 min/day; modify school meals and snacks; and involve families in making behavioral and environmental changes at home. Reported that changes in school physical activity were not significant and intervention children experienced a 13.4% incidence of overweight, whereas the control children experienced a corresponding incidence of 24.8%.
Elementary (Kindergarten to First Grade)
Midwest (Pine Ridge Reservation, South Dakota)
454
Cherokee Choices25	Developed a program with three main components: elementary school mentoring, worksite wellness for adults, and church-based health promotion. Reported school policy was altered to allow more class time and after-school time devoted to health promotion activities.
Elementary (Kindergarten through Sixth Grade)
Southeast (Eastern Band of Cherokee Indians, North Carolina)
~600
Pathways22,33,42,47,48,79–84,101–124	Conducted a randomized controlled intervention trial over 3 consecutive years that had four components: change in dietary intake, increase physical activity, a classroom curriculum focused on healthy eating and lifestyle, and a family-involvement program. Reported no significant reduction in percentage body fat. Motion sensor data showed similar activity levels in both the intervention and control schools.
Elementary (Third through Fifth Grade)
Multiple (seven American Indian communities)
1704
Quest21	Implemented a program that had four components: biochemical and anthropometric assessments, classroom instruction about diabetes, increased daily physical activity at school, and a structured school breakfast and lunch program. Reported preliminary results indicated that a school could provide a stable environment for behavior change that slows weight gain in early childhood.
Elementary (Kindergarten through Second Grade)
Southwest (Gila River Indian community, Arizona)
>200
The Checkerboard Cardiovascular Curriculum23,37	Pilot-tested a cardiovascular health education curriculum. Reported significant increases in knowledge about the cardiovascular system, exercise, nutrition, obesity, tobacco use, and habit change.
Elementary (Fifth Grade)
Southwest (Navajo & Pueblo tribes, New Mexico)
218
The Southwestern Cardiovascular Curriculum24	Conducted a delayed intervention with three stages of intervention: basic curriculum only, basic curriculum plus peer pressure unit, and control (no intervention). Reported preliminary data indicated students experienced positive changes in health knowledge, attitudes, and behaviors.
Elementary (Fifth Grade)
Southwest (Navajo & Pueblo tribes, New Mexico)
Not reported
Youth Wellness Program28,43	Trained community members to lead in-school physical activity classes two times per week. Reported over the two year study period the percentage of youth with a high fasting blood glucose level of more than 125 mg/dL decreased concurrently with significant improvements in fitness measures.
Elementary (Third through Eighth Grade)
Southwest (The Hualapai Tribe, Arizona)
71
Zuni Diabetes Prevention Program32,44	Used a multiple cross-sectional design to compare outcome measures of a diabetes prevention program including an educational component and a youth-oriented fitness center against an Anglo comparison group. Reported plasma glucose levels were normal at baseline for Zuni and Anglo youth and did not significantly change throughout the study.
High School (Juniors and Seniors)
Southwest (Zuni Pueblo, New Mexico)
72
Summer Day Camp
Healthy Living in Two Worlds26	Developed a wellness curriculum to increase physical activity, decrease or prevent recreational tobacco use, and increase healthy eating practices in a summer day camp format. Reported program participants appeared to be physically active and their activity seemed to have increased after the program.
Elementary (9 to 13 years)
Northeast (urban Northeastern population)
16
Supervised Classes
Journey to Native Youth Health27,46	Modified the diabetes prevention program to be developmentally and culturally appropriate for Native youth and delivered program through randomized small groups led by community members. Reported changes favoring the program were observed in measures of physical activity, knowledge, attitude and beverages, and kilocalories from fat consumed but no overall effect on body mass index was found after the short (three-month) duration of treatment.
Elementary (10 to 14 years)
Northern Plains (two Montana Indian reservations)
64
The Ho-Chunk Youth Fitness Program40	Conducted a 24-week intervention that consisted of twice weekly classes with supervision for both nutrition and exercise. Reported mean fasting plasma insulin decreased after 24 weeks of training but percent body fat, glucose, and total cholesterol remained unchanged during this time.
Multiple (6 to 18 years)
Midwest (Ho-Chunk Tribe, Wisconsin)
38
Workshop
STOP Diabetes!41	Piloted an educational intervention about diabetes. Reported positive post-workshop knowledge scores and 90% of the participants reported positive workshop experience.
High School (13 to 18 years)
Midwest (Winnebago Indian Reservation, Nebraska)
28