Table of Contents
PICOT Question
In a group of participants ages 18 to 25 (P), does the provision of education regarding the importance of exercising 300 minutes per week (I), compared to a similar group that does not receive the education (C), increase their level of activity by 30% (O) by the end of a 6-month period (T)?
The PICOT question used for this research project includes an intervention group that will receive education and a control group that will not enroll in an educational program. The adherence to exercise as well as the frequency and amount of exercise done by both groups will be compared. The study also includes a clear period during which the experiment will take place. The selected period will indicate the potential level of effect of the intervention should it produce a significant result.
Evidence Synthesis
| PubMed | Study #1 | Study #2 | Study #3 | Study #4 | Study#5 | Synthesis |
|---|---|---|---|---|---|---|
| (p) Population | Women with low bone mineral density (osteopenia or osteoporosis) who had been through a successful wrist fracture treatment | Overweight women with a body mass index of ≥30 | People with musculoskeletal conditions | Older adults affected by chronic conditions | Patients diagnosed with hemophilia (case report of a 16-year old male) | Evidence located during the research session includes diverse population groups of different ages, background, sexes, and with different health statuses |
| (i) Intervention | OsteoACTIVE – an exercise program combines with educational sessions. | Group-delivered exercise training program with educational elements that was monitored by nurses | Exercise program delivered by a physiotherapist | A diverse set of strategies designed to improve adherence to exercise among older adults | The use of behavior change approach to motivate adherence to exercise | |
| (c) Comparison | Patients that received educational sessions only and no training exercise program | No control group. The results registered before and after the implementation of intervention were compared | The results of an intervention group that received app and website-supported training program with supplementary, motivational phone calls were compared to those of a control group whose program was delivered as a paper handout | A systematic review that compared multiple studies where different strategies aimed at the improvement of exercise adherence motivation were researched | Different strategies used to encourage and motivate physical activity are compared with one another with the focus on the behavior change strategy | A diverse body of literature with items that use control groups, rely on the single-group design and perform reviews of evidence collected systematically |
| (o) Outcome | The level of adherence to physical exercise in both participant groups | The impact of an exercise program on further adherence to exercise among the participating individuals | The level of adherence to physical exercise among the members of the intervention and control groups | The most effective strategies that encourage adherence to exercise among older adults | The levels of effectiveness of various strategies aimed at the improvement of exercise adherence and focused on behavioral change | Most of the reviewed studies tested the effect of different strategies and approaches on the long-term adherence to exercise |
| (t) Time | Follow-up after six months and one year | Follow-up after six months and one year | Adherence tested after four weeks | Many diverse time periods | Many diverse time periods | The collected evidence presents data about periods of various lengths that were used to test the levels of adherence to exercise |
Evidence Evaluation
| Citation | Design | Sample size: Adequate? | Major variables: Independent Dependent | Study findings: Strengths and weaknesses | Level of evidence | Evidence synthesis |
|---|---|---|---|---|---|---|
| Hakestad, K., Torstveit, M. K., Nordsletten, L., & Risberg, M. A. (2015). Effect of exercises with weight vests and a patient education programme for women with osteopenia and a healed wrist fracture: A randomized, controlled trial of the OsteoACTIVE programme. BMC Musculoskeletal Disorders, 16(352), 1-9. | Randomized controlled trial | Relatively small sample. The intervention group included 42 patients, and the control group – 38. Only 35 patients completed the trial | Independent variable – OsteoACTIVE – an exercise program combines with education. Independent – the level of exercise adherence among women with low bone mineral density | Weakness- small sample size. Strength – a very specific focus in terms of participants’ features; a lengthy and repeated follow-up plan | Level II | A well-organized and detailed study that provides insights into the potential causes of non-adherence to exercise |
| Rey-Moya, L., Castilla-Álvarez, C., Pichiule-Castañeda, M., Rico-Blázquez, M., & Escortell-Mayor, E. (2013). Effect of group intervention in the primary healthcare setting on continuing adherence to physical exercise routines in obese women. Journal of Clinical Nursing, 22(15-16), 2114-2121. | Quasi-experimental single group pretest and posttest study | 174 women affected by obesity. An adequate sample | Independent variable – a training program delivered over the course of seven weeks. Dependent variable – the continuing level of adherence to exercise among obese women | Weakness – a limitation by the patients’ age. The potential for the existence of factors affecting study results due to the lack of a control group and randomization. Strength – a lengthy delivery of the intervention and a repeated long-term follow-up showing adherence one year after the intervention was delivered | Level III | A well-organized study that included no control group and no randomization but showed the dynamics of adherence to exercise within a single group |
| Lambert, T., Harvey, L., Avdalis, C., Chen, L., Jeyalingam, S., Pratt, C.,… Lucas, B. (2017). An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: A randomised trial. Journal of Physiotherapy, 63, 161–167. | Randomized controlled trial | Both the intervention and control groups included 40 participants. This sample size is adequate but quite small. | Independent variable – the effect of an app with remote support versus a program presented on handouts. Dependent variable – the level of adherence to exercise among the participants | Weaknesses – a relatively small sample that may turn out unrepresentative due to its size; a short follow-up period. Strengths – the RCT design | Level II | A thoroughly built RCT study that measured the effectiveness of different ways of information delivery on exercise adherence among patients with musculoskeletal conditions |
| Room, J., Hannik, E., Dawes, H., & Barker, K. (2017). What interventions are used to improve exercise adherence in older people and what behavioral techniques are they based on? A systematic review. BMJ Open, 7, 1-13. | A systematic review | Eleven studies with diverse designs were included. This sample is adequate. | Independent variables – various strategies aimed at the improvement of adherence to exercise. Dependent – the level of exercise adherence demonstrated by the participant groups | Weaknesses – the insufficient number of RCT studies in the sample, the potential for interpretation bias. Strengths – the inclusion of a broad and diverse body of literature | Level V | An inclusive systematic review that focused on a variety of strategies helping increase adherence to exercise in older adults |
| Goto, M., Takedani, H., Yokoto, H., & Haga, N. (2016). Strategies to encourage physical activity in patients with hemophilia to improve quality of life. Journal of Blood Medicine, 7, 85-98. | A descriptive study with a case report | A thorough literature review with and a report of a case of a single patient. This sample size is adequate. | Independent variable – strategies for exercise adherence improvement based on behavioral change. Dependent variable – the level of response to these strategies among patients with hemophilia | Weaknesses – the lack of comparison the inclusion of evidence from a single case. Strengths – the focus on the dynamics and mechanisms of a specific kind of strategies | Level VI | A descriptive case report study with a strong literature review focusing on the effectiveness of behavioral change strategies in the achievement of exercise adherence |