Benchmark – Evidence-Based Practice Project: Literature Review

Evidence-Based Practice Project: Literature Review

Practice problems are widespread in healthcare and are linked to adverse outcomes, including workplace incivility, high healthcare costs, and job dissatisfaction. The high prevalence of type 2 diabetes among older adults is a significant nursing problem that deserves much attention from care providers, policymakers, and leaders. Nursing research shows that type 2 diabetes is associated with increased patient visits, increased healthcare costs, and high vulnerability to cardiovascular disease (Cigolle et al., 2022; Evans et al., 2022). These outcomes underline the need for effective interventions at healthcare facilities and communities. Besides, type 2 diabetes inhibits functional performance and independence among older adults (Ahmad et al., 2022). Due to their central role in primary care and change implementation, nurses should explore interventions tailored to improve older adults’ functional capacity and independence. Such interventions are the foundation of healthy living among this unique group, which reduces clinical visits and healthcare costs. The purpose of this paper is to review current, peer-reviewed literature on articles supporting the PICOT.

PICOT statement:  In older adults with type 2 diabetes (P), does a twice-weekly tailored physical exercise training program (I), compared to no exercise interventions (C), improve functional fitness and independent living (O) in 8 weeks (T)?

Search Methods

Many research articles evaluating the link between physical exercises and functional ability among older adults are available online. However, many do not fit the criteria for translational research. As a result, specific keywords were used to retrieve appropriate articles from the leading databases such as CINAHL Plus, PubMed, Embase, Medline, and the Cochrane Library. Google Scholar was also used due to the ease of access to articles and other appropriate research materials. The keywords and phrases include “older adults with type 2 adults and physical exercises,” “effects of physical exercises among older adults with type 2 diabetes,” “physical exercises and functional ability among older adults with type 2 diabetes,” and “physical exercises and health among older adults.” In the search process, Boolean Operators (and, or, no) help to filter and improve results (Gray et al., 2020). From the above phrases, the operator “and” was used to refine the search process to get better results.

Synthesis of Literature

The articles explore the value of physical exercises among older adults in various dimensions and provide detailed information to support the PICOT. In the first article, Zarco et al. (2021) engaged nine older adults at Adelphi University in a guided exercise program (Essentrics). The primary objective was to examine the perceived benefits of the program as far as physical health is concerned. Typically, Essentrics involve eccentric training and stretching (Esmonde-White, 2023; Zarco et al., 2021). To determine the link between variables, older adults participated in a one-hour Essentrics program twice weekly for a year. Zarco et al. (2021) then conducted focus group discussions with open-ended and close-ended questions on motivation for trying and proceeding with the program and its benefits. Data transcription and thematic analysis revealed that older adults perceived the Essentrics program positively since it improved their functional mobility, balance, energy, and flexibility. These findings support the PICOT by demonstrating the value of physical exercises in improving functional fitness and independence among older adults.

In a different study, Kirwan et al. (2021) evaluated the effectiveness of the Beat It program on anthropometric measures, physical fitness, and psychological outcomes among older adults with type 2 diabetes. Pivotal in improving diabetes management, the Beat It is a clinician-led, twice-weekly supervised group exercise and education program (Kirwan et al., 2021; Kirwan et al., 2022). Participants were 588 older adults with type 2 diabetes mellitus (T2DM) from separate locations in New South Wales and the Australian Capital territory. After guiding older adults in the twice-weekly group exercises for eight weeks, Kirwan et al. (2021) collected data on anthropometric measures and physical fitness levels and compared it with baseline data. Height and weight measures were used to calculate body mass index (BMI), while the program’s effectiveness was assessed via paired T-tests. Researchers found a significant improvement in weight, physical fitness, and waist circumference post-program. Based on these findings, physical exercises are a foundation of improved functional fitness and healthy independent living, as the PICOT hypothesizes.

Harrison et al. (2020) focused on the motivators, barriers, and benefits associated with active engagement in physical activity and exercises among urban-community-residing older adults. In this qualitative study, 58 older adults enrolled in Senior Companion and Respite Aid programs in Washington and participating in various physical activities at the community level were enrolled. Researchers collected data on critical variables such as physical activity and exercise levels, food intake, and demographics through focus group discussions. Participants answered a short survey of about 5-8 questions assessing the health benefits of physical exercises among the participants. The thematic analysis demonstrated physical activities as a healthy living approach that prolonged life, increased physical energy, and strengthened the body. Strong bodies and high physical energy are essentials of body fitness and instrumental to independent living among older adults. As a result, the article supports the PICOT by demonstrating the value of physical exercises in improving functional fitness and independence among older adults with type 2 diabetes by increasing physical energy and body strength.

In the fourth article, Syue et al. (2022) studied how physical activity, functional fitness, and life satisfaction are related among community-dwelling older adults. Guided by the hypothesis that higher physical fitness leads to better functional fitness and life satisfaction, researchers conducted a cross-sectional study among 623 older adults in functional fitness and health screen stations in Chi-Yi City. Participants engaged in physical activity exercises of varying intensities, primarily dancing and strenuous household chores, and data was collected via the International Activity Questionnaire (IPAQ) form in 2016 and 2017. Multiple tests, such as the curl, chair, and stand tests, were used to assess functional fitness. Data post-study revealed that physical activity increases functional fitness and life satisfaction among older adults. Accordingly, the findings support the PICOT by positively linking physical exercises with better functional fitness, which is the proposed project’s primary objective.

Comparison of Articles

The four articles’ main similarity is that they evaluate how physical exercises improve functional fitness and independent living among older adults. Their findings are also positive, underlining the significance of physical exercise programs in healthcare facilities and at home for healthy, independent living among older adults with type 2 diabetes. Concerning differences, Kirwan et al. (2021) and Syue et al. (2022) are quantitative, while Harrison et al. (2020) and Zarco et al. (2021) are qualitative articles. The settings where the studies took place, and the intensity and length of physical exercise sessions also differ. Overall, the central theme is the value of physical exercises in improving functional fitness and how older adults perceive them positively. Guided participation is highly recommended for improved outcomes.

In the qualitative articles (Harrison et al., 2020; Zarco et al., 2021), researchers conducted focus group discussions and analyzed data thematically. Kirwan et al. (2021) analyzed the outcomes of the Beat It program, while Syue et al. (2022) conducted a cross-sectional study. Regarding the conclusions, the researchers conclude that interventions focused on promoting and improving physical exercises are essential to increase older adults’ potential for better health and well-being. Governments and care providers should prioritize policies to encourage and sustain such exercises. Limitations include limited generalizability due to a small sample size (Zarco et al., 2021), a lack of a comparison group (Kirwan et al., 2021), a short survey period (Harrison et al., 2020), and the inability of a cross-sectional study to demonstrate the cause-effect relationship between variables (Syue et al., 2022). No controversies have been identified since all researchers found a positive link between physical exercises and better functional ability.

Suggestions for Future Research

Translational researchers find different gaps that should guide future research. For instance, Kirwan et al. (2021) suggested longer-term follow-up studies to establish whether the positive changes from the Beat It program can be maintained beyond the program’s delivery period. Based on the overall findings, another area of future research is the potential risks of physical exercises, considering the frailty of older adults with type 2 diabetes. In this case, their implementers should be guided effectively to ensure that the intensity does not exceed the healthy limit. Another important focus area is whether significant differences exist between rural and urban community-dwelling adults based on their lifestyles and health perceptions.

Conclusion

Nursing literature on interventions to improve health among older adults is extensive. As the reviewed literature demonstrates, moderate physical exercises effectively improve functional fitness and independence among older adults with type 2 diabetes. To achieve the desired results, older adults should be guided and monitored appropriately. Nursing professionals should also ensure barriers and motivators are adequately evaluated to encourage participation in physical exercises and maximize their benefits.

References

Ahmad, E., Sargeant, J. A., Yates, T., Webb, D. R., & Davies, M. J. (2022). Type 2 diabetes and impaired physical function: a growing problem. Diabetology, 3(1), 30-45. https://doi.org/10.3390/diabetology3010003

Cigolle, C. T., Blaum, C. S., Lyu, C., Ha, J., Kabeto, M., & Zhong, J. (2022). Associations of age at diagnosis and duration of diabetes with morbidity and mortality among older adults. JAMA Network Open, 5(9), e2232766-e2232766. doi:10.1001/jamanetworkopen.2022.32766

Esmonde-White, M. (2023). The miracle of flexibility: a head-to-toe program to increase strength, improve mobility, and become pain free. Simon and Schuster.

Evans, M., Chandramouli, A. S., Faurby, M., Matthiessen, K. S., Mogensen, P. B., & Verma, S. (2022). Healthcare costs and hospitalizations in US patients with type 2 diabetes and cardiovascular disease: a retrospective database study (OFFSET). Diabetes, Obesity & Metabolism, 24(7), 1300–1309. https://doi.org/10.1111/dom.14703

Gray, J. R., Grove, S. K., & Sutherland, S. (2020). Burns and Grove’s the practice of nursing research-E-book: Appraisal, synthesis, and generation of evidence. Elsevier Health Sciences.

Harrison, E. A., Lord, L. M., Asongwed, E., Jackson, P., Johnson-Largent, T., Jean Baptiste, A. M., … & Jeffery, T. (2020). Perceptions, opinions, beliefs, and attitudes about physical activity and exercise in urban-community-residing older adults. Journal of Primary Care & Community Health, 11, 2150132720924137. https://doi.org/10.1177/2150132720924137

Kirwan, M., Chiu, C. L., Hay, M., & Laing, T. (2021). Community-based exercise and lifestyle program improves health outcomes in older adults with type 2 diabetes. International Journal of Environmental Research and Public Health, 18(11), 6147. https://doi.org/10.3390/ijerph18116147

Kirwan, M., Chiu, C. L., Laing, T., Chowdhury, N., & Gwynne, K. (2022). A web-delivered, clinician-led group exercise intervention for older adults with type 2 diabetes: Single-arm pre-post intervention. Journal of Medical Internet Research, 24(9), e39800. https://doi.org/10.2196/39800

Syue, S. H., Yang, H. F., Wang, C. W., Hung, S. Y., Lee, P. H., & Fan, S. Y. (2022). The associations between physical activity, functional fitness, and life satisfaction among community-dwelling older adults. International Journal of Environmental Research and Public Health, 19(13), 8043. https://doi.org/10.3390/ijerph19138043

Zarco, E. P. T., Aquino, M., Petrizzo, J., Wygand, J., & McGorry, A. (2021). Perceived benefits of a guided exercise program among older adults. Gerontology and Geriatric Medicine, 7, 23337214211060147. https://doi.org/10.1177/23337214211060147