The KaHOLO Project: Preventing Cardiovascular Disease in Native Hawaiians

Native Hawaiians (NH) have higher rates of chronic diseases, such as cardiovascular disease
(CVD), diabetes, and cancer. Hypertension (HTN), an important modifiable risk factor for CVD,
is 70% higher in Native Hawaiians (NH) than in Whites. In fact, NH are 3-4 times more likely
to develop CVD conditions, such as stroke and coronary heart disease, and at a younger age.
In addition to prescribed medication, improvements in HTN can be achieved through increased
physical activity (PA) and self-management education (e.g. stress management, reduces sodium
intake, weight-loss, and smoking cessation). Yet, many commonly prescribed PA, such as
jogging and use of treadmills, are difficult for NH to initiate and maintain because of
socioeconomic barriers and lack of alignment with NH preferred modes of living and cultural
values (i.e. familial interdependence, group-based PA, cultural PA).

This research study uses hula, the traditional dance form of NH and hallmark of NH culture,
as the PA basis for a culturally relevant and sustainable CVD prevention program targeting
HTN management. Hula training is popular, not only Hawai'i, but across the U.S. through the
784 hālau hula (hula schools) found in most States. Using a community-based participatory
research (CBPR) framework, a hula-based CVD health intervention was strongly endorsed by Kumu
hula (hula experts and guardians of hula traditions), NH individuals, and communities.
Further, hula was determined to yield metabolic equivalent of energy expenditure as a
moderate and vigorous intensity PA. Data from a pilot CBPR randomized control trial (RCT)
study found that 60 minutes of hula training twice a week for 12 weeks reduced systolic blood
pressure (BP) by 7.5 mmHg (SD=16.5) more than the control group, but the long-term effects
were mixed and the study did not assess CVD risk.

Interestingly, the pilot intervention also improved social functioning, reduced physical
pain, and perceived racial discrimination, suggesting a possible psychosocial and
socio-cultural mechanism by which the intervention affects BP. In this study a CBPR guided
RCT of 250 NH with physician-diagnosed HTN in Hawai'i and Washington State is offered. The
effects will be compared of a 6-month intervention that combines hula training and brief
culturally-tailored HTN self-management education delivered by peer educators and Kumu hula
to a wait-list control group in reducing systolic BP and CVD risk scores. It will also be
determined the mediating effects of health behaviors (e.g., smoking), self-regulation, and
psychosocial (e.g., social support), and socio-cultural factors (e.g., perceived racism) on
blood pressure reduction. The goal is to build on the existing widespread infrastructure of
hālau hula and NH organizations to deliver a sustainable, culturally-preferred CVD prevention
program.

Inclusion Criteria:

- Native Hawaiian ancestry

- Physician diagnosed HTN

- Continued SBP>140

- Physicians approval to participate in moderate PA

- No prior CVD history

Exclusion Criteria:

- Pregnant