This is a three page article review and summary. The following parameters are addressed: Identify a research or evidence-based article that focuses comprehensively on a specific intervention or diagnostic tool for the treatment of diabetes in adults or children. In a paper of 750-1,000 words, summarize the main idea of the research findings for a specific patient population. Research must include clinical findings that are current, thorough, and relevant to diabetes and the nursing practice.
¶ … Diabetes
Umpierre, D. et al. (2011). Physical activity advice only or structured exercise training and association with HbA levels in Type 2 Diabetes. JAMA 305(17): 1790-1799.
A connection between lifestyle factors in diabetes has been well established in research. In particular, exercise is reliably linked with improvements in diabetes prognoses. However, there has been a noticeable gap in research related to what types of exercise are linked to what types of outcomes. Evidence-based practice must rely on specific guidelines that help nurses to recommend exercise programs for specific patient populations. In other words, it is not enough to tell a patient to exercise. Nurses must be able to tell their patients how to exercise, how often to exercise, and why. The Umpierre et al. (2011) study fills this significant gap in the literature by performing a systematic review and meta-analysis. The results of this study can and will inform evidence-based practice in nursing.
The patient population in this research includes adults with diabetes in the United States. Database sources and research tracked the patient population for more than thirty years, offering a large sample size and solidifying external validity. All studies included in the Umpierre, et al. (2011) research were randomized controlled clinical trials assessing the difference between structured exercise regimes including aerobic, resistance training, or both, and generic physical activity advice on change in hemoglobin A1c (HbA1c) in type 2 diabetes patients. Diet was controlled for; the studies were conducted both with and without dietary cointervention. This presents one of the most significant impediments to internal validity in this study: the researchers cannot know for sure whether diet as well as exercise caused the resulting change in hemoglobin A1c (HbA1c) in type 2 diabetes patients. However, the researchers made up for this by tracking the influence that dietary advice did have in conjunction with the type of exercise advice given. They found that "physical activity advice is associated with lower HbA1c, but only when combined with dietary advice," (Umpierre, et al., 2011, p. 1790).
Moreover, the researchers only included studies that lasted twelve weeks or longer, and that used control groups to reliably measure the impact of structured vs. unstructured exercise. A total of 4191 articles were reviewed, including 8538 patients for the current study. The independent variables were the type of exercise regime recommended by the nurse and implemented by the patient: usually aerobic exercise, resistance training, or both for the structured category; or generic physical activity advice for the unstructured category. The dependent variable was the difference in HbA1c levels between intervention and control groups. Difference in HbA1c levels between intervention and control groups was calculated using a random-effects mode.
Results revealed "structured exercise training that consists of aerobic exercise, resistance training, or both combined is associated with HbA1c reduction in patients with type 2 diabetes," supporting the research hypothesis (Umpierre, et al., 2011, p. 1790). In particular, it was found that more than 150 minutes per week is necessary to lead to measurable results: greater HbA1c declines vs. any exercise undertaken with less than 150 hours per week frequency. When exercise frequency was less than 150 hours per week, dietary changes were required to bring HbA1c declines within the same range as the structured exercise group. The results suggest that structured and frequent exercise alone, without dietary changes, can lead to improved outcomes for adult patients with diabetes. The results possibly also suggest that a combination of diet and structured exercise can lead to remarkably improved outcomes for adult patients with diabetes. Likewise, the results suggest that patients who prefer to exercise in an unstructured manner can still reap rewards by combining unstructured exercise regimes with dietary changes.
Nurses should be made aware of the specific types of exercise associated with improved outcomes, so that recommendations to patients are based on evidence. This research shows that 150 minutes per week of "moderate-intensity aerobic exercise" plus resistance training performed three times per week is the type of structured regime necessary to yield measurable declines in HbA1c. The decline is about .6%, indicated by this meta-analysis. The authors note that since their research was published, subsequent studies showed that the ideal scenario is for patients to combine aerobic with resistance training.
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