Heidi Toth

Sept. 4, 2019

The sun came up again today. I saw it.

So many of the patients who came to Denise McClellan, Jason Pedwaydon and other personal trainers shared that sentiment in some way. Tomorrow wasn’t promised, but they had today. So they were going to make today count.

But they were going to do their best to make good on tomorrow, too.

That was the motivation for 82 participants in a study that looked at how physical activity helped Native American cancer survivors to heal, recover and find a healthy lifestyle. The study, which was part of the Partnership for Native American Cancer Prevention (NACP), was a collaborative effort between Northern Arizona University and the University of Arizona Cancer Center. Researchers looked at whether a program that included weekly exercise sessions with a trainer, combined with a home exercise program and regular health monitoring, could help the group become healthier.

The project ended Aug. 31, so it’s too soon to officially say yes, it does, but anecdotally—yes, it did.

“What we’re finding is just movement itself is rehabilitative,” said Brenda Charley, coordinator of the project. “That’s one reason we let friends and family in. We want to make sure they understand they’re doing something good for themselves too.”

The project focused on Navajo cancer survivors and their caregivers and Native American, mostly Navajo personal trainers—getting them valuable experience and preparing for certification to send them back to their communities with the skills needed to continue in this work.

The need for this research

For a long time, medical research tended to treat everyone as a monolith, not taking race, gender and other demographic factors into account. As a result, Native Americans’ unique needs were overlooked. Dirk de Heer, an associate professor of health sciences and principal investigator in the NACP, looked for holistic ways to fill that research gap that not only focused on Native Americans’ health but also met the research subjects where they were, leaving space for tradition as they worked out and tracked calories. If that meant wearing a Fitbit with ceremonial dress, then that’s what they did.

“There is an enormous need for translational research with the Navajo Nation and other tribal nations in our region,” de Heer said. “People often travel very far to receive care and screening, not to mention the additional barriers related to poverty and cultural misalignment in our health care system. Even more importantly, there is a need to train local personnel, support workforce development and work directly with regional providers.”

This gap is largely what the NACP was created to address; all of the associated researchers are asking cancer questions about Native populations. In 2013, the program sent out a call for pilot proposals on which NAU and U of A researchers collaborated. De Heer received recommendations from now-provost Diane Stearns, who was the NACP research lead at the time, and connected with NAU nursing professor Anna Schwartz and Jennifer Bea, a cancer exercise and body composition researcher at U of A. Etta Yazzie, an oncology nurse Arizona Oncology Associates, also joined the team as one of the few oncology providers in the region with in-depth knowledge of the Native American culture. Jointly, they developed a project aimed at Native American cancer survivors and how physical activity could help them live longer, healthier lives.

After the first round of research, they received funding for a five-year project and took on more partners, including the Native Americans for Community Action (NACA), the Leupp Chapter, research specialist Taylor Lane, now a Ph.D. student in interdisciplinary health at NAU, and several Native American students from both NAU and U of A, including Gold Axe winner Shelby Dalgai, Agassiz Writing Award winner Kaitlyn Haskie, former Miss Indigenous NAU Jayme Biakeddy and many others.

The focus group phase aimed at understanding barriers and facilitators to physical activity among cancer survivors. It was followed by a pilot study where the researchers developed and tested a physical activity intervention for cancer survivors. It started in Flagstaff and Leupp, but the researchers realized quickly that traveling further reduced clients’ likelihood of success, so they opened clinics in Tuba City and Winslow as well. They also realized Native Americans, who place a high value on family and community support, did better with access to that support, so the team expanded the study to include caregivers.

“This is incredibly important in the Native American culture and history of kinship,” de Heer said. “In addition, family members of cancer survivors are often themselves at higher risk of developing cancer, which makes a physical activity program an important preventive measure.”

The results bore out that early observation, he said; patients who participated with family members had increased motivation and adherence to the protocol as well as an easier time with logistics like getting to the training center.

Each participant signed up for an 18-week period. For 12 weeks, they would meet once a week with a trainer, talk about their progress, set goals, work through challenges and then get an exercise regimen for the next week. That regimen usually consisted of a certain number of minutes of cardio and several strength-training exercises that used body weight or resistance bands or pulled “weights” from the average person’s home, like soup can rows.

The participants also had a six-week period, either before they started the weekly sessions or after, where they were still providing data but not actively meeting with a trainer. Each participant had measurements, including weight, waist and hip size, A1C blood tests, blood pressure and other indicators taken at the start of the project and at six weeks, 12 weeks and 18 weeks.

The trainers also explained what those data meant, Charley said; often, patients didn’t know what an A1C reading was and whether their number was good or worrisome. (It’s a test that measures blood sugar and is used to diagnose Type 2 diabetes and prediabetes.)

It wasn’t always easy; Charley said technological issues like Fitbits simply not working on the reservation required the team to shift methodology as they went, resorting to questionnaires to gather information about food intake and how many minutes worked. And even the questionnaires weren’t all that effective; she found that most of the participants wrote little information down, but they were happy to sit down with her or a trainer and talk about what they’d done that week.

Although the trainers worked directly with clients, they had a conference call once a week with de Heer, Yazzie, Bea, Schwartz, Lane and Charley, discussing each client in-depth. The trainer working with each individual would explain that person’s progress and challenges, the regimen they’d just finished and the upcoming regimen they were considering. The experts would weigh in, making tweaks and providing direction as needed.

Finding Native solutions

Much of the motivation behind this study was to examine the beliefs and knowledge of Native Americans related to cancer, physical activity and treatment and then to turn around and use that knowledge to provide treatment that was in keeping with Native culture while also offering the best medical care possible.

A major component of this is the personal trainers themselves, who coached participants through exercises, talked to them about how they were feeling and explained how they might not have lost weight, but they lost inches and gained skeletal muscle and that’s even better. Because all of the trainers were Native, they understood the traditions and the prayers and the directions from a medicine man. When a client came in having just done a ceremony, wearing ceremonial clothing and unable to do certain tasks, the trainers took it in stride and worked around those limitations. Once, McClellan conducted client sessions in ceremonial dress. No explanation was needed.

“We had to be creative in not letting them feel uncomfortable because they came dressed the way they were, with those kinds of limitations,” Charley said.

The mutual understanding of tribal traditions and belief made these training gyms a safe place for clients. Although it’s too soon to know the data, anecdotally, the trainers said they saw differences. They saw commitment and desire and understanding.

“Many of them haven’t exercised because they don’t know what good exercise feels like, what movement can do for them mentally, physically and emotionally,” Charley said. “Or they forgot. A lot of them talk about their childhood, how they used to run all the time and be out playing, then they grew up and forgot how to do those things. Our job is to connect them back to it.”

The trainers are more than happy to be that link. Pedwaydon, who is of the Ottawa, Chippewa and Delaware tribes, is a cancer survivor. He talks about how his uncle, a medicine man, told him not to pound the earth or he risked the cancer returning. Pedwaydon put his snowboard away forever.

“Cancer sucks,” he said, to nods from his fellow trainers. “To see these individuals who are patients—survivors—trying to help themselves, and this is a new concept for them, that exercise is medicine. And guess what? You need medicine.”

One memorable day western and Native medicine collided for Pedwaydon. One of his clients showed up with a small bag. They walked through the PT routine, and the man kept the bag close, shifting it around as he performed the exercises.

Finally, Pedwaydon asked him what was in the bag.

“That’s my medicine,” the client said matter-of-factly. “It’s my chemo.”

For McClellan, who is Navajo, the difference is more than physical. She watched patients watch out with greater confidence in themselves and their ability to heal and become stronger.

“They start to live it, is what they do,” she said. “We assign their at-home programs, and they try to implement it in their lives. And most of them did! They applied it in their lives.”

“That’s where you guys come in,” said Anthony Santos with a nod. Santos, a second-year Ph.D. student in the interdisciplinary health program, oversees the trainers, including helping them study for the ACSM certification. “You can travel all over the Navajo Nation and can confidently educate and push people toward a healthier lifestyle. You can be a true service to the Navajo people for sure.”

That’s also what de Heer and his collaborators envisioned when the program started. It’s why they—a team of certified, highly qualified health professionals—are not on the ground working with clinics. Preparing the trainers for continued work with Native people after the study has ended is a critical outcome.

“Local trainers and workforce development are incredibly important for sustainability of everything we try to do,” de Heer said. “They live in the communities we work in, and supporting their career development is as important as our intervention. The knowledge and experience they build will carry on and continue to help their communities.”

Results and next steps

At this point, they’re preliminary, but the data show positive trends in weight loss at six weeks and fitness and quality of life at 12 weeks. Plus, patients just reported feeling better, with more energy and more excitement for life.

The team will continue studying the data, looking at possible next steps in approaching Native Americans’ approach to cancer care. The findings for this study will be presented at the Navajo Human Research Review Board Conference in October and the American Association for Cancer Research on Cancer Health Disparities in September.

Besides the benefits to cancer research, students who participated in this program also saw benefits. Many Native American students have gone on to medical school, graduate programs in public health and completed internships and fellowships at organizations like the National Institutes of Health and Harvard. De Heer said, in addition to the NACP (which is funded in part by the NIH), donations from the John and Sophie Ottens Foundation made such internships possible.

“It is my hope that these students will not only support but lead many projects in their own communities in the future that address the needs of cancer survivors and their families,” de Heer said.

Aug. 26, 2019

As the threat of climate change grows—and with it, the specter of more extreme conditions such as wildfires, droughts and tropical storms—cities throughout the U.S. are developing policies to reduce their emissions of greenhouse gases, chiefly carbon dioxide (CO₂). Even though many local governments are committed to these goals, the emissions data they have to work with are often too general to provide a useful baseline and target the most effective policy.

Professor Kevin Gurney of Northern Arizona University’s School of Informatics, Computing, and Cyber Systems today published results in Earth Systems Science Data detailing greenhouse gas emissions in the Los Angeles Megacity—the third-largest metropolitan area in the world—occupying 4,850 square miles and housing more than 18.5 million people. In collaboration with scientists at Arizona State University, the University of Michigan, the National Institute of Standardized Technology (NIST) and NASA’s Jet Propulsion Laboratory, Gurney developed the high-resolution, bottom-up emissions map that includes every building and road in the basin for a staggering emissions total of 176 million tons of CO₂ per year.

Gurney, who specializes in atmospheric science, ecology and public policy, has spent several years developing a standardized system, as part of the Hestia Project, that quantifies and visualizes greenhouse gases emitted in urban regions down to each street and building, identifying problem areas and showing where public policy is—or is not—making a difference. His goal is to provide cities with a means to strategically address problem areas instead of taking a sweeping and costly approach.

“We’re providing city stakeholders with a scalpel instead of a hammer. For example, about 60 percent of roadway emissions come from 10 percent of the roads. With Hestia, I can tell them which roads those are, and they can develop specific policy to address just those roads,” Gurney said. “The same is true for buildings. We can identify the ones with the highest emissions and track how well efforts to reduce those emissions are working. Policymakers can see progress.”

LA first megacity mapped in long-term project

Mapping Los Angeles was the latest effort in a long-term project that involves collaborators at NASA, the National Oceanic and Atmospheric Administration (NOAA), NIST, the University of Colorado, Pennsylvania State University, the Scripps Institution of Oceanography at the University of California, San Diego, the University of Utah, GNS Science in New Zealand and Purdue University. Other cities Gurney has mapped to this degree are Indianapolis, Salt Lake City and Baltimore. However, Gurney expects the Los Angeles mapping to have the most significant implications, especially considering the sheer size and scope of the area.

“It’s the first megacity for which we’ve quantified emissions down to the scale of every building and roadway. Nothing has been left out of an area that includes 80 cities and five counties,” Gurney said. “California has an aggressive policy when it comes to carbon dioxide emissions, and people want to know what the best policy options are and whether those policies are working. We can provide the information to local governments and they can take immediate action. And if we can do this for the entire Los Angeles Megacity, we can do it anywhere in the United States.”

One of the strengths of the approach is the incorporation of atmospheric monitoring of CO₂ from ground-based and satellite instruments.

“By synthesizing the detail of building and road-scale emissions with the independence and accuracy of atmospheric monitoring, we have the best possible estimate of emissions with the most policy-relevant detail,” Gurney said.

Animated graphics help people visualize their city and their personal emissions to illustrate how their actions are affecting the environment in which they live. Gurney hopes that will inspire people to become more engaged in policy development.

“When people see emissions from everyday activities mapped within the context of their block, neighborhood or city, they are more likely to become involved in the solution process,” Gurney said.

Data from the LA Basin mapping project are available on the NIST website.

Gurney joined NAU in 2018, where he is continuing the research he started while at Arizona State University and prior to that at Purdue University. He has been involved with the United Nations Climate Change Framework Convention and the Kyoto Protocol for 25 years. In addition to his interests in carbon cycle science and policy, he has worked on stratospheric ozone depletion, radionuclide dose assessment and energy systems and climate-economic modeling.

Aug. 22, 2019

Pools of old carbon in the soil of boreal forests historically safe from combustion are being released by more frequent and larger wildfires, a team led by researchers at Northern Arizona University announced in Nature this week. As the climate of these forests in the Northwest Territories of Canada becomes warmer, drier and prone to more frequent fires, the combustion of “legacy carbon,” as the research team calls it, has the potential to shift the global carbon cycle, as boreal forests that have acted as carbon sinks for millennia become sources of atmospheric carbon.

The research team, which included collaborators from NAU, the government of the Northwest Territories (NWT), four Canadian universities, University of Alaska-Fairbanks and Woods Hole Research Center, found that legacy carbon remained protected from combustion in older stands where the historical fire return interval persisted. But in stands younger than 60 years old, legacy carbon burned.

“In older stands that burn, this carbon is protected by thick organic soils,” said Xanthe Walker, lead author and postdoctoral researcher at the Center for Ecosystem Science and Society (Ecoss) at Northern Arizona University. “But in younger stands that burn, the soil does not have time to re-accumulate after the previous fire, making legacy carbon vulnerable to burning. This pattern could shift boreal forests into a new domain of carbon cycling, where they become a carbon source instead of a sink.”

For Walker and senior author Michelle Mack, who first identified these protected pools of carbon in fire scars in Alaska, a series of mega-fires in the Northwest Territories in 2014 offered an opportunity to ask whether legacy carbon was being combusted, and where.

“These were large and severe fires, and we thought: This is when and where it would burn,” Walker said.

“We know that there is really old carbon in these soils—carbon that is hundreds to thousands of years old, carbon that is irreplaceable,” said Mack, who worked with Walker and NAU collaborators Chris Ebert, Scott Goetz and Ted Schuur on the study. “As high-intensity fires begin to burn these stores, we think of this as ‘mining’ soil carbon. Globally, boreal forests store about one-third of terrestrial carbon, primarily in soils, so transferring that carbon from soil to the atmosphere could be a powerful accelerating feedback to climate warming.”

To ensure they sampled a full spectrum of burned areas, Steve Cumming of Laval University in Quebec identified plots in the burn area with maps derived from remote sensing of forest composition. Then Walker and a large field campaign of researchers and students from Canadian universities hiked into the burn areas to sample the soil at 211 of these plots.

“Carbon accumulates in these soils like tree rings, with the newest carbon at the surface and the oldest carbon at the bottom,” Mack said. “We thought we could use this layering to see how far back in time, in the history of the forest, fires were burning.”

To estimate the age of the carbon in the soil, the team used radiocarbon dating, which measures the abundance of 14C carbon isotope in a sample of soil. Carbon dating allows researchers to measure the amount of 14C and gather clues about how long certain carbon stores have been in the soil. This technique requires a high-precision measurement made by relatively few labs in the world; in early 2020, Ecoss will install a Mini Carbon Dating System at NAU.

In nearly half (45 percent) of the young stands the researchers sampled, legacy carbon burned. And while the amount of legacy C didn’t alter total carbon emitted from these fires, the pattern the researchers identified has global implications for future climate scenarios.

“The frequency of boreal forest fires is projected to increase even more with expected climate warming and drying, and as a result total burned area is expected to increase 130-350 percent by mid-century,” the authors write, expanding the proportion of young forests vulnerable to burning and loss of legacy carbon.

“By defining and analyzing ‘legacy carbon,’ this paper offers a new way to think about long-sequestered carbon stocks in boreal forests and how vulnerable they are to being burned during increasingly frequent and severe wildfires,” said Brendan Rogers, a scientist at Woods Hole Research Center who co-authored the Nature study. “This tool helps us understand when burning goes ‘outside the norm’ from a historical perspective and begins to combust carbon stocks that survived past fires.

“Second, this study further emphasizes why more frequent burning in the boreal forest is bad from a climate perspective.”

“The 2014 wildfires were unlike anything the Northwest Territories had experienced, and after them, the Government of the NWT sought to understand the impacts of extreme wildfire on the lands and people of the NWT so they could better plan and adapt,” said Jennifer Baltzer, a researcher at Wilfrid Laurier University in Ontario and co-author of the Nature study. “This research, with their help and partnership, has really advanced our understanding of these fires and the tremendous impact extreme wildfire years have on globally critical stores of carbon.”

“The good news here is that this landscape in the Northwest Territories is comprised primarily of old forests, and legacy carbon stayed protected there,” said Walker, who earned her PhD. with biologist and co-author Jill Johnstone at the University of Saskatchewan. “Young stands lack accumulated fuel and acted as a kind of fire break. But as the climate continues to warm and grow drier, we may see that change, and young stands may begin to carry fire and threaten legacy carbon.”

This project was a collaborative effort primarily supported by funding awarded to Michelle Mack by the NASA Arctic Boreal Vulnerability Experiment (ABoVE) and a National Science Foundation (NSF) Division of Environmental Biology (DEB) Rapid grant. Additional funding was provided by: Natural Sciences and Engineering Research Council (NSERC) Discovery Grants awarded to Jill Johnstone and Merritt Turetsky; the Northwest Territories Cumulative Impacts Monitoring Program awarded to Jennifer Baltzer; an NSERC postdoctoral fellowship awarded to Nicola Day; and Polar Knowledge, Canada’s Northern Science Training Program awarded to Canadian field assistants. Logistical support was provided by the Government of the Northwest Territories–Wilfrid Laurier University Partnership Agreement.

Above graphic by Victor O. Leshyk, Ecoss