Effectiveness of Aerobic Exercise
Effectiveness of Aerobic Exercise
Effectiveness of Aerobic Exercise
Submitted by
Chinyere Christiana Pamugo
A Direct Practice Improvement Project Presented in Partial Fulfillment
of the Requirements for the Degree
Doctor of Nursing Practice
Grand Canyon University
Phoenix, Arizona
January 11, 2023
© by Chinyere Christiana Pamugo, 2023
All rights reserved.
GRAND CANYON UNIVERSITY
Effectiveness of Aerobic Exercise on Ambulatory Blood Pressure in Hypertensive Patients
Chinyere Christiana Pamugo
has been approved
January 11, 2023
APPROVED:
Dawn Robinson DNP, MSN, RN, LNHA, DPI Project Chairperson
Khoa Don Nguyen, MD., DPI Project Mentor
ACCEPTED AND SIGNED:
________________________________________
Lisa Smith, Ph.D., RN, CNE
Dean and Professor, College of Nursing and Health Care Professions
_________________________________________
Date
Chapter 1: Introduction to the Project
Hypertension (HTN) is a medical condition associated with higher blood pressure, whereby the arteries that transport blood become damaged. Despite the availability of treatment strategies, less than one in five individuals have their blood pressure under control (Ghatage et al., 2021). Currently, in the United States (U.S.), the disease poses a significant problem that affects over half of the adult population (37 million individuals) (Centers for Disease Control and Prevention [CDC], 2021; Krist et al., 2021). Complications of the condition include myocardial infarction, heart failure, chronic renal disease, and stroke (Ghatage et al., 2021).
The increase in the cases of hypertension prompted the American Heart Association Task Force (AHA, 2022) to publish new guidelines to help manage the rise in hypertension among American adults (Wang et al., 2019). One critical change within the AHA guideline is the improvised reference and definition of hypertension values. The American College of Cardiology and the American Heart Association guidelines for hypertension management and definition of HTN defines it as having blood pressure at or above 130/80 mmHg (The American College of Cardiology (2022); American Heart Association, 2022). At the same time, stage 2 HTN is blood pressure at or above 140/90mmHg (CDC., 2021). Improved blood pressure (BP) among hypertensive patients has been associated with positive health outcomes (Severin et al., 2020), and early detection and control of BP have significantly impacted morbidity and mortality rates in the healthcare delivery system (CDC, 2021; Severin et al., 2020).
At the project site, the project manager collaborated with the Medical Director and clinical manager regarding the increasing ambulatory blood pressures seen within the past three months. Although the site provided patients with medication management for their disease, it was suggested that another strategy be employed to help reduce blood pressure.
The conversation concluded with the project manager translating and implementing Saco-Ledo et al.’s (2020) research on aerobic exercise to impact the blood pressure of hypertensive patients.
The project was worth conducting because it helped to increase HTN patients’ knowledge levels and assist in helping them change their behaviors to combat this “silent killer” (Centers for Disease Control and Prevention [CDC], 2019). Unfortunately, many individuals are unaware of the symptoms, which makes the situation dire. This project promoted decreasing the fifth leading cause of death (CDC, 2019). Other areas the project impacted were improving their quality of life, reducing their chances of stroke, protecting their kidneys, and decreasing healthcare costs (CDC, 2019).
Chapter 1 introduced the topic of hypertension and the use of daily physical activity to combat the disease. Other sections of the chapter included the problem statement, purpose statement, and clinical question. Other chapter areas encompassed advancing scientific knowledge related to the theoretical underpinnings, quantitative methodology, and quasi-experimental design. The chapter’s last segments comprised the definition of terms, assumptions, limitations, and delimitations with a preview of Chapter 2.
Background of the Project
The prevalence of hypertension among the adult population in the United States (U.S.) increased rapidly between 1988 to 2010, accounting for half of all fatalities from stroke and end-stage renal disease (ESRD) (Million Hearts, 2021). According to Muntner et al. (2020) trend analysis, the estimated proportion of the U.S. adult population suffering from hypertension between 1999 and 2000 was 31.8 %. The adult population affected by hypertension increased from 31.8 % in 1999-2000 to 48.5 % in 2007 and 2008 (Muntner et al., 2020). The number of affected U.S. adults has been on the rise ever since, and between 2013 and 2014, which was 53.8 % (Muntner et al., 2020). The percentage dropped slightly from 53.8% to 43.7% between 2017 and 2018, but the value is still relatively high (Muntner et al., 2020). This data imply that the American population is considerably affected by hypertension at an alarming rate.
The current hypertensive population impacted by increased ambulatory blood pressure is 43.7%, according to a recent study by Adams and Wright (2020). Currently, there are no standardized guidelines for educating hypertensive patients regarding incorporating exercise (daily physical activity) as a blood pressure management mechanism at the project site. The standard treatments include medications such as diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and calcium channel blockers (Mayo Clinic, 2021). After collaborating with the medical director and nursing staff, the decision was to implement Saco-Ledo et al.’s (2020) research on aerobic exercise to help lower systolic and diastolic blood pressures among this clinic’s adult hypertensive population.
Problem Statement
It was not known if or to what degree the translation of Saco-Ledo et al.’s (2020) research on aerobic exercise would impact systolic and diastolic blood pressures when compared to current practice among adult hypertensive patients. 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 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 Health and Human Services Commission (2022), as the county ranks 22 in the States with diagnosed hypertensive patients. The data, in combination with current literature by the Centers for Disease Prevention and Control [CDC] (2021), emphasizes that hypertension affects approximately 45% of American adults.
The project contributes to the current body of literature, such as Aung and Htay (2021), Krist et al. (2021), and Saco-Ledo et al. (2020), regarding aerobic exercise being included in hypertension management. The CDC (2020) states that regular physical activity is essential for general wellness, weight loss, and well-being. Other areas impacted are the reduced symptoms of depression and anxiety (CDC, 2020). The project validated that using aerobic exercise, as stated by Saco-Ledo et al. (2020), decreased one’s systolic blood pressure by approximately 2 to 4 mm Hg in normotensive and 5 to 8 mm Hg in hypertension adult patients.
Purpose of the Project
The purpose of this quantitative, quasi-experimental quality improvement project was to determine if the translation of Saco-Ledo et al.’s research on aerobic exercise would impact systolic and diastolic blood pressures when compared to current practice among adult hypertensive patients in a primary care clinic in southwest Texas over four weeks. The independent variable for the project was the translation of Saco-Ledo et al.’s (2020) research on aerobic exercise, and the dependent variable was blood pressure measurements. Convenience sampling was used to choose the patients during office visits. The project was conducted within four weeks using a quasi-experimental design and quantitative methodology. Six healthcare providers were educated to offer aerobic exercise using a translation of Saco-Ledo et al.’s research on aerobic exercise. The impact was measured using an Oscar 2 blood pressure monitoring device for HTN patients. The primary investigation carried out the implementation and comparison of data during the project using ambulatory blood pressure collected baseline and postimplementation. Patient blood pressures measured by the Oscar-2 were automatically imported into the patient’s medical record. Data were retrieved from the clinic’s electronic medical record and inputted into a Microsoft Excel spreadsheet. A statistician not associated with the primary investigator or project analyzed the data. A paired sample t-test was used to analyze the statistical significance of the variables using the Statistical Package for the Social Sciences (SPSS-28).
The inclusion criteria for the patients were 18 and older, diagnosed with HTN, current clinic patients, and able to participate in aerobic activity. The exclusion criteria are patients with musculoskeletal disabilities, mental disorders, and individuals with comorbidities that could bias the project findings. The patients engaged in aerobic exercise for 30 minutes in 24 hours, three days a week, for the four weeks of the project duration. The postimplementation outcome was a reduction in ambulatory blood pressure reading of the recommended BP below 140/80mmHg. The average decrease in SBP with aerobic exercise is approximately 2 to 4 mm Hg in normotensive patients and 5 to 8 mm Hg in adult hypertension patients (Saco-Ledo et al., 2020).
The individuals who implemented the intervention were one physician, two nurse practitioners, two registered nurses, and one medical assistant. All healthcare providers were educated to include aerobic exercise within office visits with HTN patients. Aerobic exercise was offered as translated from Saco-Ledo et al.’s (2020) research on aerobic exercise. The use of Oscar 2 Device for measuring ambulatory blood pressure. The clinicians demonstrated understanding via the teach-back method to the project manager to safeguard all the patients were taught the same way. They currently work full-time at the clinic for over one year and have access to the documentation software.
The project site’s geographic location is in southwest Texas, the most populous county and the third most populous county in the United States (U.S. Census Bureau, 2020). The affected population was patients diagnosed with HTN. The demographics show a diverse population of White (28.9 %), White-Hispanic (36.72%), Blacks (18.5%), Asians (6.9 %), and Latinos (8.98. %) (U.S. Census Bureau, 2020). Many residents over the age of 60 have chronic diseases such as (chronic obstructive pulmonary disease, heart disease, and diabetes) (UT Health Science Center at Houston, 2020). The age groups in the county 18 to 34 (20,586), 35 to 54 (46,513), and 55 to 64 reflect the patients in the project.
The project contributed to the nursing field by offering an evidence-based strategy and evaluating how aerobic exercises such as walking improve ambulatory blood pressure. The project provided vital information that could be shared with other nursing staff or healthcare providers at other primary care clinics, minority communities, or populations in similar diverse populations. The project also preferred an avenue for helping individuals and families to understand the relationship between the disease process and its management.
