Associate Professor Susan Brumby1,2
1 Deakin University
2 National Centre for Farmer Health
beyondblue Victorian Centre of Excellence
Project completion year
Recent studies indicate that rural and regional Australians have a higher likelihood of suffering a mental disorder throughout their lifetime than people living in major cities (AIHW, 2010), although the reasons underlying this imbalance are yet to be well defined.
Obesity is also a growing problem worldwide (WHO, 2011). In 2004-05 the Australian Bureau of Statistics (2009) National Health Survey determined that approximately 54 per cent of adults aged 18 and over were classified as overweight or obese. Interestingly, it is rural populations that experience poor outcomes in mental health and the lifestyle-associated co-morbidities of obesity, diabetes and cardiovascular disease (Alston, 2004 & Mathers 2001).
Ongoing studies by the researchers and the Sustainable Farm Families™ (SFF) program reveal that farmers face higher mental health burdens and higher rates of obesity and associated lifestyle disease than the age-adjusted rural and national averages (Brumby et al 2011). Not only do farming populations experience higher incidence of mental and physical illness, they face further burdens to health including the tyranny of distance, access to health services, the distance decay effect and predicted climatic and environmental challenges.
Participants were recruited from first year SFF programs run throughout Victoria in 2010. In addition to attending the SFF program, participants needed to have a body mass index (BMI) greater than 25 (kg/m2) to be eligible for the study. SFF programs were pre-assigned to intervention and control groups; the researchers did not have access to participant data before assigning these groups.
Both groups were offered free health assessments measuring height, weight, body fat percentage and blood pressure; and fasting venous blood tests for glucose, cortisol, total cholesterol, triglycerides, high-density lipoprotein (HDL) and low density lipoprotein (LDL) following a 10-hour fast. Additionally, the intervention group was given an exercise program devised by an experienced exercise physiologist, with ongoing support through phone coaching by the research assistant.
Questionnaires pertaining to exercise levels and dietary behaviours were administered along with a food recall (for the previous day) and the Depression and Anxiety Stress Scale (DASS21) (Lovibond and Lovibond 1995) psychological questionnaire at baseline, three month and completion of the project. Participants also completed salivary cortisol tests at these time-points in the program. For these tests, participants had to avoid food for one hour prior to the four test times during the day (9am, 12 midday, 4pm and 8pm). Results were then posted back to the laboratory at the Deakin Medical School.
Seventy-two participants (35 interventions, 37 controls) out of the anticipated 100 participants were recruited from SFF programs due to a limited number of participants meeting the Farming Fit selection criteria. In an attempt to boost numbers, the required BMI was lowered from ≥27 to ≥25. Four participants chose to withdraw from the project during the study (34 intervention, 34 control participants completed the study).
The Farming Fit program utilised the Depression, Anxiety and Stress Scale 21 items (DASS 21) to measure psychological distress. Saliva testing was added to the methodology. Salivary cortisol assessment is widely accepted and frequently employed method of measuring circulatory cortisol.
Statistically significant post-intervention reductions were detected only for the intervention group (not in the control group) on the following parameters:
- body weight (p<0.001)
- BMI (p<0.001)
- waist circumference (p=0.05)
- serum triglycerides (p<0.05)
- systolic/diastolic blood pressure(p<0.05)
Among the intervention group, positive (more healthy) changes were also observed on other health markers including reduction of serum cortisol (409.5nmol/L to 373.7nmol/L), total DASS score (17.5 to 16.5) and increases of physical activity. The changes only trended to improvement within the intervention group, although they were not statistically significant.
Participants of the intervention group reported statistically significant reduction in obesity measures (BMI and waist circumference). Serum cortisol levels also reduced in the intervention group who participated in the exercise-coaching program. These results support the research hypothesis of the Farming Fit cycle which describes the role of improving physical activity on improving psychological state, reducing circulating cortisol levels and reducing adiposity.
Translation of the findings into practice
The experience and the clinical knowledge achieved as a result of the Farming Fit study program has also been used to further refine course contents in the Agricultural Health & Medicine units (HMF701 & HMF 702), which are offered by the Deakin School of Medicine through the NCFH. These units provide the current and next generation rural and agricultural leaders with the knowledge and skills required to improve the health, safety and wellbeing of rural and remote Australians.
As part of the Farming Fit study, a DVD of simple exercises has been produced so rural and remote individuals can undertake physical activity without having to rely on sophisticated gyms or equipment.
Key findings of the Farming Fit study can be found online at www.farmerhealth.org.au
Brumby, S., A. Chandrasekara, S. McCoombe, P. Kremer, and P. Lewandowski, Farming fit? Dispelling the Australian agrarian myth. BMC Research Notes, 2011. 4(1): p. 89.
Brumby, S., A. Chandrasekara, S. McCoombe, S. Torres, P. Kremer, and P. Lewandowski, Reducing psychological distress and obesity in Australian farmers by promoting physical activity. BMC Public Health, 2011. 11(1): p. 362.