Research Article Critique and Ethical Considerations
Verreijen, A. M., Engberink, M. F., Memelink, R. G., Plas, S. E., Visser, M., & Weijs, P. J. (2017). Effect of a high protein diet and/or resistance exercise on the preservation of fat-free mass during weight loss in overweight and obese older adults: A randomized controlled trial. Nutrition Journal, 16(1), 2-8. Web.
Background of Study
Older adults are the fastest-growing population globally. Obesity occurs in 20 to 30% of this population. Obesity in this age group is a big health problem because of its connection to chronic health problems such as diabetes and cardiovascular disease, which lower the quality of life (Flegal, Kruszon-Moran, Carroll, Fryar, & Ogden, 2016). Weight loss is known to improve metabolic and functional activities. Nonetheless, a possible problem linked to weight loss among older adults is the loss of skeletal muscle mass that hastens the advancement of sarcopenia (Verreijen et al., 2017). Therefore, a safe way to lose weight with minimal side effects is resistance exercise alongside the consumption of high-quality protein. The benefits of resistance exercise are attributed to the stimulation of muscle protein formation that upholds muscle mass and functionality. However, there are limited trials involving weight loss in obese older adults as well as trials that merge resistance exercise with high protein diets.
Though not stated explicitly, the inferred research question is whether a protein-rich diet and resistance exercise prevent muscle loss when obese adults attempt to lose weight. The purpose of the study is to determine the impact of a high protein diet and resistance workout on the preservation of FFM throughout weight loss in obese and individuals (Verreijen et al., 2017). The purpose and research questions were related to the research problem of loss of muscle mass in attempts to lose weight. The authors provide a possible way of helping adults to lose weight safely without muscle loss.
Methods of Study
The authors do not identify any risks or benefits associated with participating in the program. However, they assure the safety of the process by reporting some of the safety measures that were taken. For example, they report that the exercise program was established by proficient instructors and a physiotherapist. Additionally, the training sessions were overseen by qualified trainers.
Subjects provided informed consent on paper. Additionally, some participants withdrew from the study in the initial stages, which suggests that the subjects took part willingly in the study. The authors obtained institutional review board approval from the “Medical Ethics Committee Independent Review Board Nijmegen, Netherlands”, where the study was conducted (Verreijen et al., 2017, p.8). The authors identify and describe the dependent and independent variables. The independent variables were diet (high protein and normal protein) and exercise (presence or absence of resistance exercise). On the other hand, the dependent variables were alterations in body weight, FFM, and fat mass (FM).
Data collection involved subjecting 100 overweight subjects aged between 55 and 80 years to a 10-week weight loss course. All subjects consumed a low-calorie diet during that time. The subjects were arbitrarily assigned to a protein-rich or conventional protein diet with or without resistance exercise. The resistance exercise program was undertaken 3 times a week. Air dislodgment plethysmography was used to determine FFM. The exclusion criteria included subjects who had taken part in a recent weight loss program, when undertaking the resistance training program was deemed detrimental by a physiotherapist, or inability to adhere to the entire study procedure. The study occurred between May and December 2014 at the Amsterdam University of Applied Sciences (Verreijen et al., 2017).
The rigor of the process was assured by using a random number generator to randomize the participants into the treatment groups. Measurements were taken at the baseline, after 5 weeks and 10 weeks following the intervention. Additionally, double-data entry was conducted during which inconsistencies were verified and corrected. However, no rationale was provided for the chosen data collection method.
Data analysis involved statistical procedures with FFM change as the key outcome. Data from 84 out of the initial 100 participants subjects were analyzed at the end of the study period. Version 22 of SPSS software was used at a statistical significance of α=0.05. The authors enlisted the help of other experts such as dietitians and fitness instructors to minimize the effects of researcher bias. However, there was no independent comparison of data.
Results of Study
It was noted that the prescribed diet and exercise did not alter the body weight and other muscle mass constituents significantly. Additionally, there was no notable interaction between protein and exercise for FFM. However, it was evident that a combination of high protein with exercise led to a significant increase in FFM. The findings are a true manifestation of reality. I have confidence in the findings due to the detailed account of data collection. However, I expected a significant interaction between protein and exercise.
The researchers identified several limitations of the study, the first of which is the withdrawal of participants from the study before the baseline measurements were taken. The consequence of this withdrawal was an uneven distribution of the subjects. The observed weight loss was lower than anticipated. Also, the subjects received a bi-weekly consultation with a dietitian as opposed to weekly consultations in previous studies that realized bigger weight loss margins. Another shortcoming was the length of the study, which was deemed too short to achieve meaningful weight loss. Overall, the presentation of the findings was logical. The authors presented the findings in a step by step fashion that made it easy for a reader to follow.
The findings of this study can be applied to nursing practice, particularly adult populations. Although the majority of the subjects in the study were aged 55 years or older, the findings apply to all adult populations. However, the dominance of older populations in this study also makes the findings relevant to geriatric nursing. The aging process causes frailty, which predisposes the majority of the elderly people to chronic diseases, including lifestyle problems such as diabetes and hypertension that are attributed to obesity (Biswas et al., 2015). Incorporating exercise and diet in day-to-day nursing advice to patients can help to avert some of these complications. Future studies could look into the effects of combining protein with resistance exercise using high contrast protein diets on FFM.
Ethical Considerations
The research was permitted by the “Medical Ethics Committee Independent.
Review Board Nijmegen, the Netherlands” (Verreijen et al., 2017, p. 8). Patient privacy was protected because the identities of the subjects were not disclosed. Also, a written informed agreement was acquired from all subjects before participating in the trial.
Conclusion
Weight loss has beneficial health effects because it improves metabolism and body functions. However, in older adults, weight loss is associated with a loss of muscle mass. Therefore, there is a need to develop a customized diet and exercise regimens that facilitate weight loss without compromising muscle mass. The study reported that there was no noteworthy interaction between a high protein diet and resistance exercise regarding FFM. However, bringing together a high protein diet and resistance exercise plan has a substantial increase in FFM, which suggests the potential benefit of FFM preservation all through weight endeavors in older adults. This finding is helpful for geriatric nurses trying to promote weight loss in older patients.
References
Biswas, A., Oh, P. I., Faulkner, G. E., Bajaj, R. R., Silver, M. A., Mitchell, M. S., & Alter, D. A. (2015). Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: A systematic review and meta-analysis. Annals of Internal Medicine, 162(2), 123-132.
Flegal, K. M., Kruszon-Moran, D., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2016). Trends in obesity among adults in the United States, 2005 to 2014. JAMA, 315(21), 2284-2291.
Verreijen, A. M., Engberink, M. F., Memelink, R. G., Plas, S. E., Visser, M., & Weijs, P. J. (2017). Effect of a high protein diet and/or resistance exercise on the preservation of fat free mass during weight loss in overweight and obese older adults: A randomized controlled trial. Nutrition Journal, 16(1), 2-8. Web.