Quantitative Research Critique : Exercise Program

Cardiovascular disease is the number one killer in the United States, causing about 610,000 deaths yearly (Center for Disease Control and Prevention, 2015). Cardiovascular disease is defined as a group of disorders damaging the heart and blood vessels, usually involving the blockage of vessels, which in turn harm the heart (WHO, 2015). A 2011 American Heart Association statement predicted that without intervention, 40% of United States adults will have at least one form of Cardiovascular disease by 2030. A large portion of these deaths by cardiovascular disease is due to the sedentary population. To better prevent cardiovascular disease, the Physical Activity Guidelines for Americans Advisory Committee stated that adults should complete about 150 minutes of moderate intensity physical activity, or 75 minutes of vigorous intensity physical activity weekly (Barry, Blair, Church, Hooker, Sui, Warren, 2010). Research has shown that meeting these recommendations is linked with lower cardiovascular disease risk, as well as reduced risk of mortality. The Center for Disease Control and Prevention estimates that only about 20.3% of Americans meet these guidelines. These statistics show that the majority of the United States population does not get nearly the amount of physical activity they need. However, even though many people are not doing the recommended amount of physical activity, this may not mean that they are living a sedentary life. Living a sedentary lifestyle is

Monpere (1998) warns that this older population is further complicated by the increased prevalence of concurrent, non-cardiac chronic diseases such as chronic obstructive pulmonary disease, atrophic musculature, orthopedic contusion, hypertension, and diabetes. Not only do these conditions limit the exercise potential of these patients, but as mentioned previously, some are even contraindications for exercise-based cardiac rehabilitation. These diseases, on their own, can be extremely limiting for the quality of life for patients as well and when combined with cardiac conditions they can be

Cardiovascular and metabolic diseases are a growing problem around the world today. Not only do diseases such as diabetes and heart disease affect individuals and their lifestyles, they also affect the economy, politics, education and the professional work environment. 20-26% of individuals in the United States live with heart disease, and obesity and high blood pressure compose the greatest factors for developing this disease [20]. Studies have shown a direct correlation between the amount of sedentary time and cardiovascular and metabolic disease risk, regardless of baseline measurements [20]. Thus, increase in physical activity will decrease cardiometabolic risk factors [8]. Several studies indicate a positive correlation between physical activity and decreased cardiometabolic risk markers [2,4,11,16]. However, we now know that an individual who is getting the recommended physical activity per day can still have a large amount of sedentary time.

The major health problem selected for this project was hypertension (Harrison et al, 2011). It is identified as a cardio vascular disease risk factor such as dementia, chronic kidney disease, coronary heart disease, and stroke (NICE, 2011). It can be missed easily, as in various instances it is asymptomatic as well as it is also known as a silent killer. The Hypertension is thought to be a disease of vascular regulation ensuing from arterial pressure control mechanisms malfunction (extracellular fluid volume, rennin-angiotensin-aldosterone system, and CNS) that results in elevation of BP by means of enhanced peripheral vascular resistance, and cardiac output. There are 2 basic hypertension types. Around 90 to 95 percent of the individuals have primary hypertension which is linked with change in lifestyle as well as needs medical treatment. On the other hand, 5-10% has secondary hypertension which is linked with various other diseases for instance pregnancy, thyroid, and renal (Haslam and James, 2005). It is estimated that around 1 in 20 adults will have increased BP of 160/100 mmHg and above that results in either more than one predisposing aspects (Gemmell et al, 2006).

The following section is broken into six subsections that will assess how each topic relates to JNC 6, 7, and 8. The subsections are organized into the following: algorithms, classification of hypertension, lifestyle modifications, pharmacological treatment, and management of care. It is important to note that JNC 6 and 7 have a greater correlation in format and the types of recommendations presented to clinicians. Contrastingly JNC 8 varies in format, as well as the type of recommendations presented to clinicians, therefore each of the subsections may not contain information on JNC 8.

This shows an importance placed more heavily on the diet part of the program than on the exercise. This could have directly affected the results. In relation to the diet, the adults experienced a decrease in their urinary Na/K, their blood pressure, and their total cholesterol when they monitored the intake of healthy foods. Changes were also seen as an increase in their body mass index when they monitored the intake of unhealthy foods. These changes were not as obvious when monitoring exercise results. In regards to exercise, there were no significant correlations between the measured variables and the adults in the study.

This health promotion class does not have patient/participant outcome measures. The facilitators have yet to create a system that measures health outcomes within its participants. It is important for health promotion programs and classes to measure health outcome in order to identify areas that need improvement or adjustments. Nonetheless, the class believes it is effective since it is identifying older adults with hypertension.

One of the most important factors to keeping seniors healthy is exercise. A community exercise program would encourage exercise in this population. Initiating a senior community exercise program within a community would require a large amount interprofessional communication and collaboration. In addition, to have a successful community senior exercise program it would the involvement of several different disciplines. Important disciplines to have involved in this community exercise program would be a medical provider, nurses, therapist, and dietitian. Each of these disciplines has a different specialty that brings different knowledge to the table, which will help create a comprehensive exercise program. Similarly, the collaboration of each

2. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007; 39(8): 1435-45. Abstract available at: http://journals.lww.com/acsm-msse/Abstract/2007/08000/Physical_Activity_and_Public_Health_in_Older.28.aspx

The research paper examined for the purposes of this assignment focuses on the issues of daily physical activity level comparing it to sedentary behaviors for older post cardiac patients from age 60 to 85 years of age. The aim of the study is look at quality and quantity of exercise in cardiac artery disease (CAD) patients comparing the physical activity levels in three different categories: Acute group, Rehab group and Maintain group. The paper did not explore in depth cardiac patients live a more inactive lifestyle except to posit it is largely related to negative lasting effects of a CAD diagnosis and physical impact from this disease. There were no references from before CAD to post CAD. The rationale and purpose of the paper was clearly

Age related changes could affect anyone’s quality of life. Chronic illnesses such as hypertension and diabetes can affect physical activity. Limitations

A limitation of cross sectional studies is that the design is reliant on data which has been collected for other purposes and methods adopted cannot be controlled or changed. Studies analysed in this aimed to find methods of improving physical fitness and counteract inactivity with the use of pedometers and participants were selected via convenience and volunteer sampling (Proença et al, 2012, Zabatiero et al., 2013)).Thus participants who volunteered were most likely to have been physically active, have greater exercise capacity and thus more willing to take part than those who were less physically active. This contradicts this study as researchers are trying to find a full representation of different levels of physical activities and exercise capacity within the elderly population. This is a limitation as it does not provide full representation of elderly population and does not account for those who have been physically fit but less active. As a result, this study lacks internal and external validity as it has poor generalisability and participants are not fully representative of the general elderly

Hypertension, a condition more commonly known as high blood pressure, is a major risk factor for many medical diseases and comorbidities. Hypertension affects 1 of 3 American adults each year, leading to comorbidities such as heart disease, coronary artery disease, stroke, and kidney disease. The treatment of hypertension totals $46 billion annually ("CDC High Blood Pressure Facts," 2015). Clinical treatment guidelines, developed in 2003 by The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7), were established for clinician management of hypertensive patients. The JNC 7 produces a standard of care in classification and treatment of hypertension, establishing standards for providers to educate their hypertensive patients in areas such as lifestyle modifications and pharmacological treatment. The JNC 7 recommends that lifestyle modifications, such as weight loss and exercise, be the preliminary treatment plan for lowering blood pressure and specifically recommends a diet rich in fiber, fruits, vegetables and low fat dairy products as outlined in the Dietary Approaches to Stop Hypertension (DASH) diet (C. Hobanian et al., 2003). More currently, JNC7 recommendations have been modified in the Eighth Report of the Joint National Committee (JNC 8), increasing the baseline blood pressure goal (Sessoms, Reid, Williams, &

The baseline study of the elderly study sample are as shown in the given table. It can be observed that three-fifths of the total sample were composed of women, and also an expression of the high prevalence of diabetes, antihypertensive treatment, and CVD are evident.

Finally, as long as appropriate safety measures are taken, such as the overall assessment of the patient before starting an unsupervised exercise program and appropriate guidance given, an unsupervised physical activity program such as the one proposed here is safe and adds benefits to its practicioners, even though they are elderly hypertensive