The Importance of Exercising on Patient Education

The importance of physical training is paramount for the prevention of a whole range of harmful diseases and conditions. Low levels of physical activity, among other problems, often result in excessive weight issues, which are highly prevalent among the citizens of the U.S. A study by Dombrowski, Knittle, Avenell, Araujo-Soares, and Sniehotta (2014) suggests that 28% of Americans are inclined to lose weight. Miller (2013) states that nurses as health providers have to promote health and wellbeing among patients. Evidence-Based Practice (EBP) will help test the hypothesis of whether or not patient education could help decrease inactivity. PICOT question is as follows: In patients of age group, 18 to 25 (P) who receive education regarding the importance of exercising 300 minutes per week (I) compared to a similar group who does not receive the education (C) will increase their present level of activity by 30%(O) by the end of a 6-month study (T).

Search Strategy

The primary sources of scientific evidence were Cochrane, Medline, and CINAHL. The evidence in the researched literature was level I, II, or III. These databases are accessible from the College library. Additionally, Google Scholar was tremendous help as many sources were found through its search engine. The search was conducted with the use of keywords such as physical inactivity, patient education, adults, obesity prevention, obesity management. For relevance purposes, the sources for this research were chosen to be not older than 5 years. Most of the literature is either evidence-based or peer-reviewed, which ensures the quality and validity of the user data (Melnyk & Fineout-Overholt, 2015).

Evidence Review and Synthesis

Dombrovsky et al. (2014) state that in adults aged 18 and older there is a significant prevalence of people who attempted to lose weight but either fail or achieve the small result. The authors reviewed 45 trials and concluded that despite behavioral methods usually used by individuals achieving a small result, the weight changes were nonetheless significant for health and wellbeing due to forming a positive pattern. The study implications include medical counseling or patient education as a measure to increase the effectiveness of the weight-loss

Stanhope and Lancaster (2014) report a 15% decrease in levels of physical activity among young people of 18 to 25 years old. The authors have found the connections between this fact and harmful environmental and behavioral indicators such as air pollution, malnutrition, work or study stress, and other factors. The need for quality medical attention was specified as one of the possible solutions.

Henson et al. (2013) suggest that sedentary behaviors typical for a large portion of middle-aged and older adults increase the risk for developing diabetes. The study used objective measurements of the population such as data from portable accelerometers given to 827 people. On the other hand, active breaks in sedentary lifestyle were associated with positive cardiovascular metrics which speaks to the need for regular exercising promotion.

The theoretical basis of the study, which includes all levels of evidence, has indicated the high prevalence of health issues associated with limited physical activity. Many researchers suggest that proper education is needed to prevent and manage weight-related issues (Henson et al. (2013); Stanhope and Lancaster (2014); Dombrovsky et al. (2014)). This proves the presence of the scientific and practice issue the current project is aiming to address. Evidence synthesis and evaluation are presented in appendices 1 and 2 respectively.

Project Aim

The goal of the current project is to determine if patient education on the importance of physical exercises increases the patients activity levels at least by 30%. Significantly lower levels will be considered insignificant. The assessment of the impact that nurses have on patients in terms of education will have a positive contribution to theory and practice. The use of this education technique in practice will also enable me to develop as a professional APRN, provided the outcomes for an EBP are positive.

Methodology

The appropriate methodology for the current aim was chosen on the basis of the limited resources the author has. A quasi-experimental controlled design will be chosen as a technique to test the intervention. A quantitative method such as a survey will be used to assess pre-and-post intervention status of physical activities in patients.

Sample

Two groups with 40 patients each (total: 80) will be selected for this study. People eligible to participate are persons 18-25 years of age. No relevant perquisites to sex, marital status, occupation, or diseases are considered exclusionary for this study except conditions that prohibit active movement. The latter may be true for instance for post-operation patients and mothers in later stages of pregnancy (certain exercises are ill-advised). One group of patients will receive education about the importance of physical activity for at least 300 minutes a week. The other group will not receive such a lection. To safeguard privacy participants names or other personal details will not be collected and/or disclosed to third parties (Mazumdar et al., 2014).

Setting

A clinical setting will be used for the current study. Specifically, the evaluation surveys and short lections will be administered to patients in the clinic where the author currently conducts practice.

Intervention

To educate patients on the benefits of physical exercises, a brochure with relevant information is given to the patient during his or her visit to a clinic. This will be the main intervention tool. The brochure will contain information on what physical and social benefits regular physical activities bring. The handouts will be made in different colors to clearly outline key information. Giving a handout, a nurse should comment on why it is important to look it through.

Pre-post Intervention Evaluation

Before handing the brochure the nurse will ask an alleged participant to give his consent to participate in trials. Upon receiving such consent a nurse will gather demographics such as age, sex, diagnosed conditions, and illnesses that can hinder moving capabilities (present or not). In addition, the tool will gauge weekly physical activity. Finally, the tool will require participants to leave an email address for a follow-up. Such information will provide a baseline status of the patient. Post-evaluation will be administered online by means of an electronic survey. It will be sent to the patient by e-mail collected during the pre-evaluation stage. Microsoft Excel will be used to store the gathered data in a form of a table. SPSS statistical analysis tool will be used to calculate mean and mode and percentage for each value and for comparing the numerical values of physical activity from the pre-and-post study. The ultimate project success measure is the percentile difference of self-reported post-intervention of weekly exercise (in minutes) in the intervention group as compared to the control group.

Implementation Plan

At the commencement stage, the author during its practice will gather two groups of a total of 80 participants within the above-specified age. The sex variation will be within a 60/40 ratio to ensure statistical validity (Noble and Smith, 2015). After the pre-evaluation is done and groups are assembled, the prepared brochures will be administered either manually to patients who visited the clinic a second time or sent by email to those who do not have a scheduled visit at the nearest time. The day each patient received the brochure with information will be recorded. After six months since the day of education intervention, an email with a short post-intervention survey is sent to each participant. One week is allocated to waiting for a response. The results are calculated and presented in the form of a study report.

Outcomes Dissemination

Once the report is ready, the results will be re-organized into a form appropriate for publishing in a college scientific paper or a scientific peer-reviewed journal. If the desired outcomes are achieved, a new EBP practice will be implemented into the authors practice. Clinical authorities will be notified of the results of the study and its possible effects on daily practice. Provided, the officials exhibit interest in the intervention made a regular practice, a working group will be created to devise a new version of an official clinic brochure for patients.

References

Dombrowski, S. U., Knittle, K., Avenell, A., Araujo-Soares, V., & Sniehotta, F. F. (2014). Long term maintenance of weight loss with non-surgical interventions in obese adults: Systematic review and meta-analyses of randomised controlled trials. BMJ, 348, 1-12.

Henson, J., Yates, T., Biddle, S. J. H., Edwardson, C. L., Khunti, K., Wilmot, E. G.,& Davies, M. J. (2013). Associations of objectively measured sedentary behaviour and physical activity with markers of cardiometabolic health. Diabetologia, 56(5), 1012-1020.

Humphreys, B. R., McLeod, L., & Ruseski, J. E. (2014). Physical activity and health outcomes: Evidence from Canada. Health Economics, 23(1), 33-54.

Mazumdar, S., Konings, P., Hewett, M., Bagheri, N., McRae, I., & Del Fante, P. (2014). Protecting the privacy of individual general practice patient electronic records for geospatial epidemiology research. Australian and New Zealand Journal of Public Health, 38(6), 548-552.

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to best practice (3rd ed.). Philadelphia, PA: Wolters Kluwer

Miller, C. A. (2013). Fast facts for health promotion in nursing: Promoting wellness in a nutshell. New York, NY: Springer.

Noble, H., & Smith, J. (2015) Issues of validity and reliability in qualitative research. Evidence Based Nursing, 18(2), 34-35

Prince, S. A., Saunders, T. J., Gresty, K., & Reid, R. D. (2014). A comparison of the effectiveness of physical activity and sedentary behaviour interventions in reducing sedentary time in adults: A systematic review and metaanalysis of controlled trials. Obesity Reviews, 15(11), 905-919.

Reiner, M., Niermann, C., Jekauc, D., & Woll, A. (2013). Long-term health benefits of physical activity A systematic review of longitudinal studies. BMC Public Health, 13(1), 1-9.

Stanhope, M., & Lancaster, J. (2014). Public health nursing: Population-Centered health care in the community (8th ed.). New York, NY: Elsevier.

Appendix 1

Evidence Synthesis

(database): Cochrane, Medline, CINAHL	Study # 1	Study # 2	Study # 3	Study # 4	Study # 5	Synthesis
(p) Population	Obese adults (18 years of age and older).	Diabetic adult patients.	Individuals older than 18 years of age.	Adults older than 18 years of age.	Individuals aged 18-85 years. Patients with non-communicable diseases.	In the majority of cases, the population consisted of patients suffering from obesity and diabetes. In all the studies, adult patients were researched.
(i) Intervention	Behavioral interventions (nutrition changes and increased physical activity).	Increased physical activity and breaks in sedentary lifestyle.	Physical activity.	Physical activity.	Intentional physical activity.	All the articles intended to determine the effects of increased physical activity on patients. Several studies investigated combined interventions.
(c) Comparison	The same sample after weight loss.	The subjects are their own controls.	Absence or poor physical activity.	Patients with sedentary behavior.	The subjects are their own controls.	In some cases, subjects were their own controls. In other instances, the effects of interventions were compared to the results in the groups that did not receive them.
(o) Outcome	Weight loss maintenance.	Cardiometabolic well-being of diabetic patients.	Increased physical activity.	Reduced sedentary time.	A positive long-term effect on the health status of patients.	All the studies intended to measure qualitative health-related outcomes.
(t) time	Within 12 months.	Not specified.	Not specified.	Not applicable.	Five years.	Some of the studies investigated long-term effects while other texts did not specify the timeframe.

Table 1. PICOT elements as applied to the chosen articles.

Appendix 2

Evidence Evaluation Table

Citation	Design	Sample size: adequate?	Major Variables: Independent Dependent	Study findings: Strengths Weaknesses	Level of Evidence	Evidence Synthesis
Dombrowski, S. U., Knittle, K., Avenell, A., Araujo-Soares, V., & Sniehotta, F. F. (2014). Long term maintenance of weight loss with non-surgical interventions in obese adults: Systematic review and meta-analyses of randomised controlled trials. BMJ, 348, 1-12.	The study is a systematic review and meta-analyses of randomized controlled trials.	Overall, 45 studies have been selected for review. The sample size is adequate in terms of the current research since both quantitative and narrative syntheses have been analyzed.	The main independent variable is weight loss (Dombrowski, Knittle, Avenell, Araujo-Soares, & Sniehotta, 2014). Other variables are body mass index of patients, weight loss maintenance treatment, behavioral and pharmacological interventions, and final weight values.	It was found that behavioral interventions that center on both proper dieting and regular exercising prove to be effective (Dombrowski et al., 2014). The strengths of the research lie in its design and findings. Although it has been determined that the intervention shows a small benefit, the authors assume that it should be considered a significant outcome.	The study relies on the Level I of Evidence. It correlates with the research design and the clinical question addressed.	Based on the evidence from the article, it can be stated that proper physical activity has a potential to affect the well-being of patients positively (Dombrowski et al., 2014). However, researchers suggest that increased cardio activity should be combined with correct nutrition and pharmacotherapy to achieve significant results.
Henson, J., Yates, T., Biddle, S. J. H., Edwardson, C. L., Khunti, K., Wilmot, E. G.,& Davies, M. J. (2013). Associations of objectively measured sedentary behaviour and physical activity with markers of cardiometabolic health. Diabetologia, 56(5), 1012-1020.	It is a meta-analysis with elements of quantitative research.	According to the article, the sample comprised 878 participants; 153 from Project STAND (Sedentary Time And Diabetes) (age 32.9±5.6 years, 28.8% male) and 725 from Walking Away from Diabetes (age 63.7±7.8 years, 64.8% male) (Henson et al., 2013, p. 1012). The number of participants is adequate considering the fact that only two projects have been reviewed. In addition, since the research is quantitative in its character, the size of the sample allows providing a statistical association, and the results are illustrative of the conclusions drawn.	The main independent variables are age, gender of participants, presence of diabetes, and intake of drugs. The dependent variables are motor activity, cardiometabolic indicators, and sedentary factors.	The strengths of the article lie in its findings. Sedentary lifestyle has been proved to be detrimental to patients health. It strongly affects the well-being of diabetic patients. An interruption in a sedentary lifestyle leads to quality improvements. No weaknesses can be observed	Level II of Evidence. The article uses the findings obtained from two randomized controlled trials.	Physical activity is indicated for all individuals regardless of their age. Patients suffering from non-communicable diseases such as diabetes benefit greatly from adequate physical exercising (Henson et al., 2013). The evidence from the article reiterates the importance of physical activity.
Humphreys, B. R., McLeod, L., & Ruseski, J. E. (2014). Physical activity and health outcomes: Evidence from Canada. Health Economics, 23(1), 33-54.	The study follows the strategy of empirical research. Nonetheless, it presents descriptive statistics.	In total, 132221 individuals have been researched. The main requirement was the age limit. No individuals younger than 12 years old could participate in the study (Humphreys, McLeod, & Ruseski, 2014). The size of the sample is adequate and correlates with the purpose of the research.	The independent variables are age, gender, marital status, financial status, education, and geographical location. The main dependent variables are related to the lifestyle of the participants. Three categories have been identified, which are active, moderately active, and daily participation in physical activities.	The main outcome of the research is the gathered evidence proving the benefits of active lifestyle. Physical activities are advisable for all population groups. A particular strength of the research lies in the fact that its results can be generalized (Humphreys et al., 2014). However, the study does not determine the effects of inactivity on the current health outcomes.	Level III of Evidence. The article is a descriptive empirical study.	Despite the fact that the research has been carried out in regards to the Canadian population, its findings can be generalized. Therefore, they are relevant and applicable to the US population. Adults should be recommended to remain physically active regardless of their age.
Prince, S. A., Saunders, T. J., Gresty, K., & Reid, R. D. (2014). A comparison of the effectiveness of physical activity and sedentary behaviour interventions in reducing sedentary time in adults: A systematic review and metaanalysis of controlled trials. Obesity Reviews, 15(11), 905-919.	It is a systematic review and meta-analysis of controlled trials.	The team has researched six databases to choose the most relevant research. In total, 33 studies have been selected based on inclusion criteria (Prince, Saunders, Gresty, & Reid, 2014). The number of chosen articles is appropriate for the hypothesis brought forward by the researchers.	The independent variables are age, gender, and reasons for the sedentary lifestyle. The dependent variables are total sedentary time and sitting time.	The team suggests that controlled interventions are needed to encourage individuals to maintain an active way of living. The main strength of the article lies in the statistical association that the research provides while the weaknesses of the study are connected to its limitations (Prince et al., 2014). Some of the selected evidence has been gathered from studies with a small sample size. Therefore, it is difficult to determine whether the provided statistics can be considered illustrative of the general tendency.	The study relies on Level I of Evidence. It correlates with the research design and the question addressed.	According to the authors, large and clinically meaningful reductions in sedentary time can be expected from interventions with a focus on reducing SBs (sedentary behaviors) (Prince et al., 2014, p. 905). These findings correlate with the conclusions drawn in previous articles.
Reiner, M., Niermann, C., Jekauc, D., & Woll, A. (2013). Long-term health benefits of physical activity A systematic review of longitudinal studies. BMC Public Health, 13(1), 1-9.	The research is a systematic review of longitudinal studies.	Overall, the article evaluates 288724 patients (aged 18 and older). The total number has been calculated from 15 longitudinal studies (Reiner, Niermann, Jekauc, & Woll, 2013). The size seems adequate considering the fact that approximately 500 patients have taken part in each of the studies.	The main independent variables are age and gender of participants and their physical fitness levels. The dependent ones are outcome variables (Reiner et al., 2013).	According to the article, physical activities have had a positive effect on all the non-communicable diseases discussed in the text (Reiner et al., 2013). The particular strength of the research is linked to its long-term orientation. Importantly, its main weakness is connected to the same aspect since few long-term studies are available on the topic.	The article relies on Level II of Evidence. Although it is a systematic review, it gathers information from the studies of the second level.	The evidence from the article confirms the findings of other studies. Increased motor activity positively affects the well-being of patients (Reiner et al., 2013). Moreover, it is highly advisable for patients suffering from non-communicable diseases.

Table 2. Details on the articles.

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