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Physical Activity Levels in Alaska Native Children Participating in the Skiku/AK Nordic Program

Background: Physical activity is recommended to mitigate the incidence of obesity, but delivery of community wide initiatives is cumbersome. The challenges met by such programs are magnified when implementation transpires in the remote villages of Alaska. To overcome the difficulty of this challenge in the Arctic, the Skiku/AK Nordic cross-country skiing program was developed. The objective of this study was to evaluate whether access to Skiku/AK Nordic program would promote physical activity levels that met the daily recommendations for physical activity in Alaska Native children. Methods: Eight children (4 females and 4 males; 10±2 years/age) were recruited from Kaktovik, Alaska for participation in this study. Expert coaches and staff provided one week of cross-country ski instruction and access to ski equipment. Physical activity was monitored using ActiGraph GT3X+ accelerometers. Data collected from the devices was then downloaded and analyzed using ActiLife software. Results: The participants expended ~586 calories/day devoted to physical activity. Light and moderate physical activity was 68±38 minutes/day and 447±248 minutes/day, respectively. Conclusions: Delivery of the Skiku/AK Nordic program promoted favorable levels of physical activity in Alaska Native children. Further research is needed to assess the longitudinal and seasonal effectiveness of the Skiku/AK Nordic program.

calculated. The algorithms chosen were those that best match the characteristics of the research sample (i.e., generally accepted industry standard age ranges) [14].

Statistical Analysis
We analyzed our data using a combination of ActiLife, Microsoft Excel, and Prism 9 software programs. All data includes eight total participants. Linear regression analysis was used to determine the relationship between body weight and caloric expenditure.
Statistics were considered significant with a P-value of less than 0.05. Data are presented as means±SD.

Results
The total estimated activity-oriented energy expenditure was 3,634±3660 calories, 586±527/day, or 35±29 calories/hour. (Table 1). Participants spent a total of 4,684±2040 minutes in sedentary behavior, 341±189 minutes engaging in light physical activity, 2259±1252 minutes engaging in moderate physical activity, and zero minutes engaging in vigorous or very vigorous physical activity (Table 1).
Overall, 60±18% of time was spent engaging in sedentary behavior, 5±2% of time was spent engaging in light physical activity, and 35±17% of time was spent engaging in moderate physical activity (Table 1). There was a significant relationship between body weight and caloric expenditure ( Figure 1).
This study was not specifically powered to investigate differences between males and females. Nevertheless, males tended to be heavier (62±12 kg) than females (40±13 kg) (P= 0.06), and males shared a tendency to engage in higher levels of physical activity than females (Table 1)

Discussion
Participation in the Skiku/AK Nordic ski program seemed to substantially influence physical activity in Alaska Native children living in Kaktovik, Alaska. Using wearable biometric devices (ie., Actigraph GT3X+ accelerometers), we were able to describe a robust level of physical activity in this cohort as compared to recommendations from the which advise at least one hour of moderate to vigorous physical activity per day [8]. The total amount of physical activity exceeded recommendations by over 5 hours/day but did not include any vigorous physical activity. During the instructional period while the coaches were physically present in Kaktovik, AK, students were exceptionally focused on the delivery of the program; learning the skills, and building engagement with and trust among others [15]. The encouraging structure of the ski program, easy access to equipment, social and community expectations for participation, and curiosity among the children were likely key factors in boosting these children's physical activity during this week. Such factors may be useful considerations for utilization in future community initiatives, particularly in remote areas. These results demonstrate considerable interest in outdoor physical activity among these Alaska Native children.
Normative data has demonstrated that children should average 12,000-16,000 steps per day [16]. Although the participants in this study generally met the recommended step count, it should be noted that the activity of skiing may influence these measurements by inflation (i.e., ski movements may not be equivalent to walking). This issue limits the interpretation of our data as algorithms specifically designed for cross-country skiing are simply unavailable [17]. Therefore, we acknowledge that energy expenditure derived from wearable biometrics may not precisely delineate energy expenditure in children, and especially under these circumstances [18,19]. We also recognize the small absolute number of participants in this study but also realize that our volunteers represented ~10% of the population in Kaktovik, AK who are 18 years old and younger. Therefore, the use of the ActiGraph-based data in this particular study allowed us to demonstrate levels of physical activity in Alaska Native children that are well above the recommendations, providing support for the potential long-term efficacy of the overall program.
This study reiterated what previous studies have found: male children tended to engage in higher levels of physical when compared to female children [20][21][22]. The root of these gender differences in physical activity beckons further research, but could be associated with individual, environmental, social, and developmental differences between genders [23]. Female children may also be more negatively affected by barriers to physical activity [24]. Social influence, weather, lack of motivation, and lack of energy can all present barriers to physical activity [25]. We did not evaluate how these

Conclusions
The Alaska Native children who participated in this study demonstrated a high level of physical activity during the initial delivery of the Skiku/AK Nordic program. Informed Consent Statement: Informed consent and assent was obtained from all subjects involved in the study

Data Availability Statement:
The data presented in this study are available on request from the corresponding author. The data are not publicly available due to the fact that the participants were children from an underrepresented group of the population.