Research is a very important element for any profession and sector of the economy. Nursing research can be described as a methodical process that applies guidelines in responding to questions that concern the general practice of nursing (Keele, 2010). Research in nursing provides a validation of knowledge that already exists and as well aid in the process of development of new knowledge about the various nursing activities. In nursing practice, empirical evidence is obtained through research and such research work is geared toward finding solutions to the various nursing care activities. It is very important to have a research work that is supported by evidence. Evidence is very important for nursing practice since nursing is an applied profession.
The paper focuses on the impact of exercise on diabetic patients on treatment. Type II diabetes mellitus is increasingly becoming a public health concern both in developed and developing nations globally. The level development of the disease is increasing at a rate that is very alarming. The etiological factors related to diabetes mellitus are of genetic, behavioral and environmental origins. In the paper, the clinical question used will be formulated using the framework of PICO (Patient/Population; Intervention; Comparison Intervention if appropriate; Outcome). 50 research articles were identified since they were evidence based studies concerning the topic of interest. Out of the 50 articles, four papers were specifically selected for critical analysis. The other articles were disqualified based on the abstract and nature of the methodologies.
Explanation will be given to all the research terms used and an outline will also be given on the search strategy used for the articles. In relation to the clinical question, a synthesis of a conclusion will be done from the articles reviewed. For this essay, the answerable clinical question also known as the PICO question is; in patients suffering from diabetes mellitus, does exercise has any effect on their response to treatment and the disease process? the people in this case are the patients suffering from diabetes mellitus, the intervention is exercise, there is no comparison and the outcome is the response to treatment and disease process. In the search strategy for the articles, three databases were used including a full text of CINAHL plus, Full text of Medline, Science Directs and Wiley Online library. Key terms used in the search engine include exercise, physical activity, type II diabetes, diabetes mellitus and diabetes treatment. The only articles that were searched were those published in the English language. The publication dates of the chosen articles were limited to the year 2010 to 2017 so as to make sure only current articles were considered. Further refining was done to the search and the content type considered were only those in journal articles. From the search, articles lacking full texts were not considered.
In a study conducted by Pai, Li, Hwu, Chang, Chen, & Chang (2016) on the effectiveness of regular leisure-time physical activities on long-term glycemic control in people with type 2 diabetes; a metanalaysis was conducted to show how effective various forms of regular physical activitie are and the combined overal influence of thes activities on the contol of diabetes mellitus. The study employed a randomized control design in the research process. In the study, pysical activities during leisure time was used as an inervention for the type II diabetese patients. The particpants included adults who were above 18 years of age diagnosed with type II diabetes mellitus. Some of the liesure activities involved included yoga, swimming, walking, gardening, cycling, jogging and dancing. The prefered desine of study was a randomised control design. The interventions lasted for a duration of a minimum of 8 weeks and was not combined with any other inyerventions. The implementation was done 2-3 time every week and each episode lasted 30 minutes. The control group was taken through routine care following the advice of clinical professionals. The care incuded general physical activities, dietary control and medications.
The period of interventionn lasted between 8 to 24 weeks and each intervention lasted for a minimum of 90 minutes and a maxumum of 70 minutes. The age group of the participant was between 35 to 71 yeas of ages, with 65% being females and 35% being males. Majority of the participants recruited were those found in outpatient clinics (67%), advertisments and community centers contributed 11% and 22% respectively. The study locations were cutting across the entire globe including the United States, India, the United Kingom, Denmark, Korea, Taiwan, Italy And Midland China. Tye inerventions included walking (8), yoga (5), qigong (3) and tai chi (2). The artcle begins with an abructsthat cleasrly picks out the purpose of the research, the reasonings as well as the results. The mothodology is also articulated briefly and key factors highlited. The central text presents everything about the article and the findingsa and statistics are stated out clearly. The abstrcat gives the reader a quick impresssion of the contents of the articles and the findingsa nd conclusions of the study. The aim of the study is clealy identified in the article both in the abstract ans well as the the main text. The use of aim, rsults and duscussions allow for the effortless interparateation and flow of events. The selection process of the particpants employed the use of purposive convenient sampling which did not inconvenience the participants whatsoever. This is the most efficinet selection process as the participant selected is up to the task. the study is well designed, the results are meaningful and useful in deterninig the relationship between exercise and type II diabetes mellitus. Adequate analysis of the study was done and the discussionparts supports the results.
In a second study, Pandey, et al., (2015) analysesd the metabolic effects of exercise training among fitness nonresponsive patients with type 2 diabetes mellitus. The objective of the study was to evaluate the impact that exercise has on the metabolic parameters in participants who were suffering from type II diabetes mellitus who had not registered any improvements on their cardio-respiratory fitness following training. During this research, participant with type II diabetes mellitus were studied and the benefits they obtained from aerobic training. Another group of individuals were subjected to resistance training and acted as the control group.
In the study, 202 participants were involved in the study, with 63% of them being women. 57% of them registered some improvements while 36.6% of them did register any changes. Bother the individuals who responded to fitness and those who did not had significant improvements in hemoglobin, measures of adiposity and waist circumference also had significant changes. Very little difference was observed in the alterations in the metabolic parameters among those who responded and those who didnt. The control group did not have any meaningful changes in terms of their metabolic parameters.
To determine the validity of the clinical trials, the study design was critically evaluated. The study had two groups, the study group and the control group. Such forms of studies are often very effective since direct comparisons can be drawn at a glance as a conclusion arrived at form observation of the two groups. The study is validated by randomization of the subjects in to the experimental and control groups. The data collection process was also simplified as it was directly through observation and experimental analysis of the various parameters. In certain studies, the subjects are blinded in a way that they are not aware of the nature of treatment they are being subjected in to; however, in this study, no blinding was necessary since the desired outcomes had direct impacts on the participants general life. The study design endured that both the experimental and control groups has the same prognostic factors. The prognostic factors considered included age, commodities of the subjects and the stage if disease. It is important to make sure that the participants share similar prognostic factors so as to avoid bias that results from differences in certain parameters. In a case where the two groups do not share similarities, it is very hard to fairly compare them at the end of the study.
Consequently, Thent, Z. C., Das, S., & Henry, L. J. (2013) undertook a study on the role of exercise in the management of diabetes mellitus.The aim of the study was to put focus on the type and extent of exercise and its significance in the managemnt on type II diabetes melitus os as to offer education to people in the developing countries like in Asian countries. The study used a randomised controlled study design in which most of the anaysis of aerobic excesise revealed beneficail effects to type II diabetes mellitus. The study brough together a series of previously done work, analsed them and acme uo with meaningful conclusion on the impacts of excerse on diabetes. The study included all publications that foucsed on adult humans and exercise. Also included were the case-control studies, clinical cohort studies, randomised cross pilot studies, randomised case controlled trials and pre-post design studies.
Most of the programmes of exercise training were based on aerobic methods and few others were conducted on the basis of resistance exercises. Aerobic exercises were found to quite beneficial to the patients as it a very valuable strategy that influnced the physiolgical parameters and reduced risks of metabolism such as insulin resistance. Most of the randomised studies indicated that high vliumes of aerobic excersise resukts in weight loss which in the end improved the level of insulin sensitivity in the cells. The articles focused on obtaining eveidence from already published reasearch works about exercise and diabets. The focus was mainly on tehrelatioship between the two and how thy impact on each other. The indepth anaylsis of a number of studies and the level of serach that was employed gave a clear picture of the impact of exerciese on type II diabetes mellitus. The comparison of up to 25 articles gave room for very little bias and borought in the actual facts. The randomised nature of the study also ensured that the study conclusion was drawan from a wider field and geographical coverage. This ensuded that the information obtained was not limited to one particular society or race. The study however is limited in the sence that there was no actual ground work that was conducted to obtain eveidence with relation to the impact of excersie on diabetes.
To continue supporting Mendes, R., Sousa, N., Themudo-Barata, J., & Reis, V. (2016) conducted a study on the impact of a community-based exercise programme on physical fitness in middle-aged and older patients with type 2 diabetes. The aim of the study in this article is to analyze the impact of a long term combined exercise program on the physical fitness of older and middle aged patients suffering from type II diabetes. The exercise program included aerobic exercise, flexibility, and balance and resistance exercises. The article is a post-evaluation study which not experimental. There were 43 participants aged between 55 and 70 years of age. The participants were engaged in community-based program of supervised exercise; the exercise is done in three weekly sessions and every session lasts for about 70 minutes and it was carried out over a period of 90 days. The exercises included a 6 minute walk of aerobic fitness, a 30 second stand test for muscle strength, time up and goo test for balance/agility and the chair reach and sit test for flexibi...
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