Hays Lm, Pressler Sj, Damush

¶ … Hays LM, Pressler SJ, Damush TM, Rawl SM, & Clark DO. (2010). Exercise adoption among older, low-income women at risk for cardiovascular disease. Public Health Nursing 27(1): 79-88.

In an attempt to determine what factor(s) influenced the decision amongst a population of women at risk for cardiovascular disease of whether or not to adopt a regular exercise regimen as recommended by physicians, these researchers administered survey instruments to their subjects to measure levels of self-efficacy, the expectations had regarding exercise outcomes, and the subjects' own definitions of "exercise." Subjects were then given an opportunity to participate in a free exercise program over an eight-week period, and levels of participation were then compared to these baseline cognitive/psychological measurements using regression analysis in order to determine the influential internal factors. Exercise self-definition emerged as a clear indicator of exercise adoption, but the other measured factors (outcome expectation and self-efficacy levels) did not appear to have any correlation with or predictive value for exercise adoption amongst this population.

Overall Validity

The researchers took great care to control the many variables that existed with this study population, assessing and measuring many aspects of the subjects' lifestyles and habits in order to develop meaningful baseline understandings of these subjects prior to their exposure to the exercise program. These controls and the level of detail in the analysis -- both qualitative and quantitative -- that took place in an attempt to derive more meaningful information from the raw data collected in the research are prominent strengths of this article, and serve to increase its appearance of validity tremendously. On the other hand, there are two significant issues that can be found with the research article's validity, and that are weaknesses in its overall applicability and in the usefulness of its conclusions and predicted/correlated outcomes.

The first of these issues is the population bias, which is openly acknowledged by the authors; the subjects were predominantly African-American, and cultural attitudes could very well have been a factor in the observed results, and there were also other subject trends that while arguably pertinent to the issue as it manifests in the general population could still have an effect on the results that makes them less easily/certainly generalized to larger populations. The framework that the researchers utilized, namely the Social Cognitive Theory model, is also inadequate in the researchers' own view to accurately and comprehensively describe the factors that influence decision making when it comes to exercise adoption, advancing certain elements as potentially predictive when these elements proved not to correlate to exercise adoption, while failing to provide a full conclusive model fro exercise adoption decisions. This makes it perhaps a less-useful theory for this particular research if practical knowledge and effects that will have a real and direct impact on public health are sought in addition to purely academic gains in knowledge.

Relevance to Community Health Nursing

This research and its outcomes and conclusions will be most directly useful for nurses that are practicing in low-income and predominantly African-American communities, as this was the population of focus in the study itself and thus this is the community to which the results are the most applicable. Within this community, it is clear that community health nurses should create a focus on what constitutes "exercise" as the term is used by physicians and nurses in regards to cardiovascular health and the prevention/mitigation of cardiovascular disease and associated risk factors, in order to help patients and the community at large understand not only the need for exercise, but also the practicalities and benchmarks of that exercise. As exercise self-definition was the only predictive factor the researchers encountered in this admittedly limited study, this is the most practical and direct implication that the research has for the practice of community health nursing.