Effectiveness of Aerobic Exercise on Ambulatory Blood Pressure in Hypertensive Patients
Presented by
Chinyere Christiana Pamugo
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DNP 965: Final Oral Presentation
December 13, 2022
A Direct Practice Improvement Project Presented in Partial Fulfillment
of the Requirements for the Degree
Doctor of Nursing Practice
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Investigator’s background
Registered Nurse for XXX years
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Topic’s background
Many individuals are unaware of the symptoms for hypertension, which makes it a top priority to educate patients and their families.
In the United States, over 37 million individuals are affected (Centers for Disease Control and Prevention [CDC], 2021; Krist et al., 2021).
The American College of Cardiology and the American Heart Association guidelines for hypertension management and definition of HTN defines it as having a blood pressure at or above 130/80 mmHg (The American College of Cardiology Foundation and the American Heart Association, 2018). At the same time, stage 2 HTN is blood pressure at or above 140/90mmHg (CDC., 2021).
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Topic’s background
Complications of the condition include myocardial infarction, heart failure, chronic renal disease, and stroke (Ghatage et al., 2021).
American Heart Association Task Force (AHA) published new guidelines to help manage the increase of the disease (Wang et al., 2019).
Purpose statement
The purpose of this quantitative, quasi-experimental project was to determine if or to what degree the translation of Saco-Ledo et al.’s research on aerobic exercise would impact ambulatory blood pressure when compared to current practice among adult hypertensive patients in a primary care clinic in southwest Texas over four weeks
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problem statement
It was not known if or to what degree the translation of Saco-Ledo et al.’s research on aerobic exercise would impact ambulatory blood pressure when compared to current practice among adult hypertensive patients
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Identified problem
At the clinical site, there were no standardized guidelines for clinicians to educate hypertensive patients regarding implementing daily physical activity as a blood pressure management mechanism.
Collaboration with the medical director and some of the nursing staff showed an increase of 37.1% in diagnosed HTN patients within the past six months. The clinic’s findings corresponded with the health statistics from the Texas Department of State Health Services (2022), as the county ranks 22 in the States with diagnosed hypertensive patients
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Significance of the project
Implementing a recommended evidence-based strategy by the AHA guideline regarding aerobic exercise
Commodore-Mensah et al. (2018) state that the financial prices are significant, approximately $131-198 billion annually
This project could help decrease the financial costs associated with the disease
Hypertensive persons incur an extra $2000 yearly in healthcare expenditures compared to non-hypertensive persons (Commodore-Mensah et al., 2018).
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Clinical question
To what degree does the translation of Saco-Ledo et al.’s research on aerobic exercise would impact blood pressure when compared to current practice among adult hypertensive patients in a primary care clinic in southwest Texas?
The independent variable was the translation of Saco-Ledo et al.’s research regarding aerobic exercise, and the dependent variable is blood pressure
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Theoretical underpinnings
Dorothy Orem’s self-care deficit theory (Orem, 1995).
Kurt Lewin’s change model (Lewin, 1947).
Unfreezing
Change or Movement
Refreezing
Based on the theory, self-care is that patients must engage in to maintain and improve their quality of health (Orem, 1995). Utilizing this theory, the nurses do not see their patients as inactive or receiving health services; instead, they consider them strong and reliable to participate in daily activities and decision-making processes (Orem, 1995). Three nursing systems are defined in Orem’s nursing theory; they include wholly compensatory, partially compensatory, and supportive-educative strategies (Khademian et al., 2020).
The chosen change is Lewin’s change model. It was selected because it is a way to describe the process change versus guiding the activities that will be conducted.
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review of the Literature
Prevention of Hypertension
Systolic Blood Pressure Management
Diastolic Blood Pressure Management
Ambulatory Blood Pressure Management
Aerobic Exercise Health Intervention
Pre-Aerobic State
Post-Aerobic State
Ambulatory Blood Pressure Management
Effect of Exercise on Blood Pressure
Health Literacy Level
Self-Efficacy
Lifestyle Modification
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clinical Question
To what degree does the implementation of American Heart Association guideline aerobic exercise would impact blood pressure when compared to current practice among adult hypertensive patients in a primary care clinic in southwest Texas?
The independent variable is the American Heart Association guideline regarding aerobic exercise, and the dependent variable is blood pressures.
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Methodology
Quantitative methodology
Using numerical data
It is objective, systematic, and focused data analysis strategies (Guetterman & Fetters, 2018).
Data can be replicated (Creswell & Creswell, 2018).
In this project, the project manager will evaluate the AHA guidelines and its impact on the blood pressures of HTN patients. The dependent variable will be measured four weeks before and post project intervention. This methodology is the most appropriate because other investigators can replicate the data (Creswell & Creswell, 2018).
A qualitative methodology was not selected because this method is often thematic and subjective, and findings are produced using the participants' words verbatim (Creswell & Creswell, 2018). In this project, the project manager will not seek to understand the participants' behaviors, feelings, or lived experiences (Creswell & Creswell, 2018
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Project design
Quasi-experimental design
Determines the effect that the independent variable has on the dependent variable (Creswell & Creswell, 2018).
Participants are not randomly assigned (Creswell & Creswell, 2018).
Project manager will manipulate the independent variable
For this project, the dependent variable (blood pressure) will be measured at two different times (once before the intervention and one after the intervention (Creswell & Creswell, 2018). A correlational design was not the most appropriate for this project. It is a non-experimental design where the independent and dependent variables are measured and assessed for their correlation relationship (Creswell & Creswell, 2018).
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Instrumentation
Data source: ABPM log retrieved from the Oscar 2 device
Electronic ABP data retrieved from the electronic medical record
Before starting the ABP project, it was imperative to ensure that the device operated as required and was installed correctly on the patient (Nwankwo et al., 2020).
The electronic ABP data on the device was retrieved from a computer via a USB cable
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Data collection
Data collected four weeks pre/post implementation
Oscar 2 device
Participants walked at home three to five times weekly for 20 minutes
They were instructed to continue taking their antihypertensive medications
Tracked their process in a logbook (Mon, Wed, Fri)
Participants were re-evaluated at the clinic week four
The healthcare providers took the 24-hour ABP measurements at two-time points: baseline without aerobic exercise in week one and week four after the workout
In week four, the participants returned to the clinic to retake their ABP using Oscar 2 device. Participants ambulated around the clinic for 20 minutes wearing the Oscar 2 device. They were monitored for their walking, whether it was intense or moderate. The ABP measurements were taken after a 20-minute rest period by the staff.
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Data analysis
Descriptive data (such as age, gender, and ethnicity)
Paired Sample t-Test.
Descriptive data (such as age, gender, and ethnicity) will be collected via the clinic’s electronic medical records (evaluated using frequency counts and percentages)
The independent variable is nominal, and the dependent variable is an interval level variable (Schober & Vetter, 2019). This t-test examines the mean scores taken from the same participants (Schober & Vetter, 2019).
The level of statistical significance was set to .05 to indicate that a p-value of less than .05 will be considered statistically significant.
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results
| Variable | Descriptive Data | |
| M | SD | |
| Age | 56.50 | 7.92 |
Table 1
Descriptive Data for Age
Table 2
Descriptive Data for Gender and Race
| Variable | Descriptive Data | |
| n | % | |
| Gender | ||
| Male | 3 | 30.0 |
| Female | 7 | 70.0 |
| Race | ||
| African American | 8 | 80.0 |
| Hispanic | 1 | 10.0 |
| Caucasian | 1 | 10.0 |
Note. M = mean; SD =standard deviation
Note. n =count; % = percentage
results
| Variable | Pre | Post | t (9) | p | ||
| M | SD | M | SD | |||
| Systolic BP (mm/Hg) | 152.60 | 14.42 | 126.10 | 19.93 | 6.35 | .001 |
Chi-square test results showed a decrease in the mean systolic BP level from pre (M = 152.60, SD = 14.42) to post (M = 126.10, SD = 19.93), t (9) = 6.35, p = .001. The p-value is less than .05 which indicates that the decrease in mean systolic BP was statistically significant. Clinical significance was supported by the 26.50 mean decline in the systolic mean levels after the intervention.
Table 3
Paired t-Test Results for Systolic Blood Pressure Levels
Note. M = mean; SD =standard deviation
results
| Variable | Pre | Post | t (9) | p | ||
| M | SD | M | SD | |||
| Diastolic BP (mm/Hg) | 87.30 | 11.19 | 78.10 | 8.45 | 2.56 | .031 |
Chi-square test results showed a decrease in the mean diastolic BP level from pre (M = 87.30, SD = 11.19) to post (M = 78.10, SD = 8.45), t (9) = 2.56, p = .031. The p-value is less than .05 which indicates that the decrease in mean diastolic BP was statistically significant. Clinical significance was supported by the 9.20-point mean decline in the systolic mean levels after the intervention.
Table 4
Paired t-Test Results for Diastolic Blood Pressure Levels
Note. M = mean; SD =standard deviation
limitations
Small sample size
Limited time frame to conduct project (four-weeks)
Data analysis being conducted by outside statistician
First limitation: Small sample size
Second limitation: Limited time (four-weeks) a longitudinal project three or more months
Third limitation: Due to the project manager’s limited knowledge and time in conducting statistical analysis, an outside statistician not affiliated with the project or manager will perform the data analysis.
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discussion
Clinical significance was demonstrated by the 26.50 mean decline in the systolic mean and 9.20 in the diastolic mean and 9.20 in the diastolic mean levels
Based on the results, the translation of Saco-Ledo et al.’s on aerobic exercise may improve blood pressure. One recommendation for future projects is to conduct the project in other medical settings, such as medical-surgical units, women’s health, and dialysis patients.
Recommendations
The project findings showed that an educational program in combination with aerobic exercise about hypertension can result in systolic and diastolic blood pressure changes
Reproduce the intervention in other healthcare settings
Conduct longitudinal project (one year or longer)
For nurse managers to pay attention to the HTN risk in their older employees (age 40 and above)
Evaluate the patient’s health stressors that can contribute to hypertension
references
Centers for Disease Control and Prevention, (2021). Facts about hypertension in the United States. https://www.cdc.gov/bloodpressure/facts.htm
Commodore-Mensah, Y., Selvin, E., Aboagye, J., Turkson-Ocran, R., Li, X., Himmelfarb, C., Ahima, R., & Cooper, L. A. (2018). Hypertension, overweight/obesity, and diabetes among immigrants in the United States: An analysis of the 2010–2016 national health interview survey. BMC Public Health, 18(1), 1-8. https://doi.org/10.1186/s12889-018-5683-3
Creswell, J.W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5thed.). Sage Publications.
references
Ghatage, T., Goyal, S., Dhar, A., & Bhat, A. (2021). Novel therapeutics for the treatment of hypertension and its associated complications: Peptide- and nonpeptide-based strategies. Hypertension Research, 44(7), 740-755. https://doi.org/10.1038/s41440-021-00643-z
Guetterman, T., & Fetters, M. (2018). Two methodological approaches to the integration of mixed methods and case study designs: A systematic review. American Behavioral Scientist, 62, 900-918.https://doi.org/10.1177/0002764218772641
Krist, A., Davidson, K., Mangione, C., Cabana, M., Caughey, A., Davis, E., Donahue, K., Doubeni, C., Kubik, M., Li, L., Ogedegbe, G., Pbert, L., Silverstein, M., Stevermer, J., Tseng, C., & Wong, J. (2021). Screening for hypertension in adults. JAMA, 325(16), 1650-1656. https://doi.org/10.1001/jama.2021.4987
references
Lewin, K. (1947). Frontiers in group dynamics: concept, method, and reality in social science; social equilibria and social change. Human Relations, 1, 5–41.
Nwankwo, T., Coleman King, S. M., Ostchega, Y., Zhang, G., Loustalot, F., Gillespie, C., & Merritt, R. (2020). Comparison of 3 devices for 24-hour ambulatory blood pressure monitoring in a nonclinical environment through a randomized trial. American Journal of Hypertension, 33(11), 1021-1029.https://doi.org/10.1093/ajh/hpaa117
Orem, D. E. (1991). Nursing: Concepts of practice (4th ed.). Mosby.
Schober, P., & Vetter, T. (2019). Descriptive statistics in medical research. Anesthesia & Analgesia, 129(6), 1445-1447. https://doi.org/10.1213/ane.0000000000004480
Wang, D., Hatahet, M., Wang, Y., Liang, H., Bazikian, Y., & Bray, C. (2019). Multivariate analysis of hypertension in general US adults based on the 2017 ACC/AHA guideline: data from the national health and nutrition examination survey 1999 to 2016. Blood Pressure, 28(3), 191-198. doi: 10.1080/08037051.2019.1593042
Effectiveness of Aerobic Exercise on Ambulatory Blood Pressure in Hypertensive Patients
By Chinyere Christiana Pamugo
Grand Canyon University, Phoenix Arizona
Introduction and Problem
Variables
Descriptive Data
Results
Results (cont.)
Clinical Question(s)
Discussion
Project Limitations
Recommendations for Future Projects and Practice
Purpose of the Project
Data Analysis
The project site is a primary care clinic in urban Texas. A convenience sample of n= 10 adult patients with HTN were enrolled in the project. Descriptive data were collected for age, gender, and race.
Table 1 displays the descriptive data for age. The mean age was 56.50 (SD = 7.92) ranging from 43 to 71.
References
The independent variable was the translation of Saco-Ledo et al.’s research regarding aerobic exercise, and the dependent variable is ambulatory blood pressure.
.
.
Centers for Disease Control and Prevention (CDC). (2021). Facts about hypertension in the United States. https://www.cdc.gov/bloodpressure/facts.htm
Krist, A., Davidson, K., Mangione, C., Cabana, M., Caughey, A., Davis, E., Donahue, K., Doubeni, C., Kubik, M., Li, L., Ogedegbe, G., Pbert, L., Silverstein, M., Stevermer, J., Tseng, C., & Wong, J. (2021). Screening for hypertension in adults. Journal of the American Medical Association, 325(16), 1650-1656. https://doi.org/10.1001/jama.2021.4987
Leedy, P., & Ormrod, J. (2020). Practical research: Planning and design. Pearson Publications.
Saco-Ledo, G., Valenzuela, P., Ruiz-Hurtado, G., Ruilope, L., & Lucia, A. (2020). Exercise reduces ambulatory blood pressure in patients with hypertension: A systematic review and meta-analysis of randomized controlled trials. Journal of American Heart Association, 15(9), 1-18. doi: 10.1161/JAHA.120.018487.
Many individuals are unaware of the symptoms for hypertension, which makes it a top priority to educate patients and their families.
In the United States, over 37 million individuals are affected (Centers for Disease Control and Prevention [CDC], 2021; Krist et al., 2021).
Using the translation of Saco-Ledo et al.’s research on aerobic exercise would impact ambulatory blood pressures.
At the clinical site, there were no standardized guidelines for clinicians to educate hypertensive patients regarding implementing daily physical activity as a blood pressure management mechanism
It was not known if or to what degree the translation of Saco-Ledo et al.’s research on aerobic exercise would impact ambulatory blood pressure when compared to current practice among adult hypertensive patients
Chi-square test results showed a decrease in the mean systolic BP level from pre (M = 152.60, SD = 14.42) to post (M = 126.10, SD = 19.93), t (9) = 6.35, p = .001. The p-value is less than .05 which indicates that the decrease in mean systolic BP was statistically significant. Clinical significance was supported by the 26.50 mean decline in the systolic mean levels after the intervention. The results are displayed in Table 3.
The results are presented to address the clinical question related to the impact of the AHA guidelines for aerobic exercise on systolic and diastolic blood pressure. A paired t-test was conducted on systolic and diastolic blood pressure at pre-and post-implementation.. The goal was to reduce ambulatory blood pressure after the intervention. Results are displayed in narrative and table format.
The purpose of this quantitative, quasi-experimental project was to determine if or to what degree the translation of Saco-Ledo et al.’s research on aerobic exercise would impact ambulatory blood pressure when compared to current practice among adult hypertensive patients in a primary care clinic in southwest Texas over four weeks
To what degree does the translation of Saco-Ledo et al.’s research on aerobic exercise would impact blood pressure when compared to current practice among adult hypertensive patients in a primary care clinic in southwest Texas
Clinical significance was demonstrated by the 26.50 mean decline in the systolic mean and 9.20 in the diastolic mean and 9.20 in the diastolic mean levels
Based on the results, the translation of Saco-Ledo et al.’s on aerobic exercise may improve blood pressure. One recommendation for future projects is to conduct the project in other medical settings, such as medical-surgical units, women’s health, and dialysis patients.
The first limitation was the restricted time to conduct the project (four weeks). A longitudinal project allows one to evaluate the trends and changes over time (Leedy & Ormrod, 2020).
The second limitation was the small sample size. The primary problem with a small sample size was interpreting the results, mainly related to the confidence intervals and p-values (Leedy & Ormrod, 2020).
The project findings showed that an educational program in combination with aerobic exercise about hypertension can result in systolic and diastolic blood pressure changes
Reproduce the intervention in other healthcare settings
Conduct longitudinal project (one year or longer)
Nurse managers to pay attention to the HTN risk in their older employees (age 40 and above)
Evaluate the patient’s health stressors that can contribute to hypertension
Descriptive data (such as age, gender, and ethnicity) including mean and standard deviation for age and frequencies and percentage for gender and ethnicity.
To examine systolic and diastolic blood pressure at pre- and post-implementation, paired sample t-tests were conducted in IBM SPSS version 28 using a level of significance of .05.
Table 1
Descriptive Data for Age
Table 2
Descriptive Data for Gender and Race
Gender and race are displayed in Table 2. There were three males (30.0%) and females made up 70.0% (n = 7). Race was 80.0% (n = 8) African American, 10.0% (n = 1) Hispanic, and 10.0% (n = 1) Caucasian.
Table 3
Paired t-Test Results for Systolic Blood Pressure Levels
Chi-square test results showed a decrease in the mean diastolic BP level from pre (M = 87.30, SD = 11.19) to post (M = 78.10, SD = 8.45), t (9) = 2.56, p = .031. The p-value is less than .05 which indicates that the decrease in mean diastolic BP was statistically significant. Clinical significance was supported by the 9.20-point mean decline in the systolic mean levels after the intervention.
Table 4
Paired t-Test Results for Diastolic Blood Pressure Levels
Note. M = mean; SD =standard deviation
Note. M = mean; SD =standard deviation
Note. n =count; % = percentage
Note. M = mean; SD =standard deviation
TEMPLATE DESIGN © 2008
www.PosterPresentations.com
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Statistics show that as at the end of 2010, an estimated 31.1% of adults (1.39 Billion) worldwide had hypertension, with many people unaware of its symptoms. This makes my projects unique as it is designed for educating patients and their families. As indicated above, complications from this health condition may include myocardial infarction, heart failure, chronic renal disease, and stroke (Ghatage et al., 2021).
Purpose of Study: My quantitative, quasi-experimental project determines if or to what degree the translation of Saco-Ledo et al.’s research on aerobic exercise can impact ambulatory blood pressure when compared to current practice among adult hypertensive patients in a primary care clinic in southwest Texas over four weeks. The problem came from the fact that at the clinical site, there was no standardized guidelines for clinicians to educate hypertensive patients regarding implementing daily physical activity as a blood pressure management mechanism. It created a problem statement that “it was not known if or to what degree the translation of Saco-Ledo et al.’s research on aerobic exercise would impact ambulatory blood pressure when compared to current practice among adult hypertensive patients.”
The significance of this project stems from the fact there is the need to implement an evidence-based strategy such as the ones recommended by the AHA guideline regarding aerobic exercise as well as the recommendation of Commodore-Mensah et al. (2018), in which it states that spending on prices are significant and is approximately $131-198 billion annually. This project potentially helps in decreasing the financial costs associated with the disease when Dorothy Orem’s self-care deficit theory (Orem, 1995) and Kurt Lewin’s change model (Lewin, 1947)’s Unfreezing, Change or Movement and Refreezing are used.
Recommendations: The discovery in this projects proved that an educational program in combination with aerobic exercise about hypertension results in systolic and diastolic blood pressure changes. Other recommendations include:
Reproduce the intervention in other healthcare settings
Conduct longitudinal project (one year or longer)
For nurse managers to pay attention to the HTN risk in their older employees (age 40 and above)
Evaluate the patient’s health stressors that can contribute to hypertension
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