Running head: EXERCISE AND HEALTH

Exercise and Health

Leah Aragon, Rachel Gonzales, Harpreet Kaur, Rebecca Shi, Mai Vang, and Arnold Velasquez
California State University, Stanislaus

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Exercise and Health
Background and Significance

Exercise is defined as activity requiring physical effort carried out to sustain or improve
health and fitness. It is widely known that exercise has a variety of health benefits such as
improving cardiovascular strength, aiding in weight management, and reducing the risk of
developing a chronic disease. Exercise has also been shown to improve mental health, promote
positive self-esteem, and enhance overall health and wellness. According to the Centers for
Disease Control and Prevention (CDC), people who are physically active also tend to live longer
(CDC, 2012). The 2008 Physical Activity Guidelines (CDC, 2011) recommend 2 hours and 30
minutes of moderate intensity aerobic activity a week, with 2 days including musclestrengthening activity. However, less than half, or 48%, of all adults meet these requirements
(CDC, 2012). Lack of exercise in the United States population is a major concern that results in
a variety of health problems leading to nursing care. Many patients are chronically ill, and it is
the nurses responsibility to not only care for the patient during their stay but also teach them
how to manage their health at home. Teaching patients about the benefits of exercise and
encouraging physical activity is important because it provides a knowledge base that may lead to
alleviated symptoms and lifestyle changes. The importance of exercise to general health has led
to further questions about exercise and how it benefits certain health problems. This paper
examines the effects of exercise on sleep quality, anxiety and stress, hypertension, Alzheimers
Disease, pregnancy, and type 2 diabetes.
Literature Review
A longitudinal study was done by Tang, Liou, and Lin (2010) to determine the effect of a
home-based walking exercise program on the sleep quality and quality of life in cancer patients.

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Researchers further assessed whether enhanced sleep quality was associated with improvement
in quality of life over time. The study was a prospective, two-armed, randomized clinical trial.
Upon approval from the university institutional review boards, participants were recruited from
the oncology outpatient clinics of two teaching hospitals in Taipei, Taiwan. A total of 71
participants were placed in one of two groups; 35 patients were allocated to usual care and 35
were placed in the exercise intervention group. Patients in the exercise group were asked to walk
three days a week and record the duration, rating of perceived exertion, and other comments
while the control group was asked to maintain their current lifestyle and record any exercise
beyond their regular routine. After data analysis, it was evident that the exercise program
significantly improved patient sleep quality. The study also revealed that enhanced sleep quality
reduced bodily pain and improved emotional and mental health over time.
Strengths of the study included protection of human participants through Institutional
Review Board approval and informed consent. In addition, the researchers performed a baseline
assessment shortly after recruitment. Another strength was that patients were randomly assigned
to either the experimental or control group using a table of random numbers. The literature
review in the introduction was also very thorough and supported the reason for the study.
Despite the many strengths of the article, there were a few limitations. For instance, there was
no stated theoretical framework. In addition, only 24 of the 36 patients in the control group
completed the full 8-week program, which may be seen as a threat to internal validity called
mortality. Despite the loss of subjects, the sample size was appropriate and verified by a power
analysis. Instrumentation was also a threat due to the self-reported instruments and the lack of
reliability and validity statistics. This study was limited by its small sample size, which may be

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seen as a threat to external validity as it may affect the generalizability of the study or whether or
not the same results would occur in another trial.
A pilot study was done by Vancampfort et al. (2011) to evaluate patients with
schizophrenia in terms of changes in state anxiety, psychological stress and subjective well being
after exercise. Forty participants in random order performed either a single 30-minute yoga
session, 20 minutes of aerobic exercise on a bicycle ergometre at self-selected intensity, or 20minutes of no exercise as control. The results showed statistically significant decreased state
anxiety, psychological stress and increased subjective well-being in the subjects who exercised
compared to the no exercise control condition. There were no significant differences between
yoga and aerobic exercise.
Strengths of the study included using a control group and the randomization in choosing
this control. There was constancy in the data collection as tests were performed on consecutive
days at the same hour without medication changes. The use of the State Anxiety Inventory and
the Subjective Exercise Experiences Scale were strengths in this study because both assessment
instruments are reliable, valid, and widely used. ANOVA was used for statistical analysis. There
were limitations in this study including the small sample size of forty. No power analysis was
done before the study. There was a high drop out rate and subjects prior motivation to exercise
was not assessed. The study only measured the immediate results of exercise as opposed to
including long-term results. No theoretical framework was found. Selection bias threatened
internal validity because all individuals were Caucasian and Belgian natives. There were no
threats to external validity.
In 2010, a study was conducted by Alparslan and Akdemir to review the effect of walking
and relaxation exercises on controlling primary and resistant hypertension. Participants (n=30)

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completed this study. The design of this study was non-experimental descriptive survey. The
measures of this study include a Patients Descriptive Determination questionnaire, Lifestyle
Evaluation questionnaire, State and Trait Anxiety Inventory, a Blood Pressure Monitoring form
and a patient diary. The findings revealed that walking and relaxation exercises were both
effective interventions for improving blood pressure levels and anxiety.
Statistical Package for the Social Sciences (SPSS) version 11.5 was used for coding and
evaluating the data and ANOVA was used for analyzing the data. The significant decreases in
blood pressure were determined by Chi Square Analysis and Fishers Exact Test. The permission
to perform this study was obtained from Hacettepe University Medical Facultys Medical,
Surgical and Drug Trials Committee in Turkey. Moreover, written permission was gained from
the facilities in which the research was conducted and from the individuals who participated.
The power analysis was performed but was not clear as to number of participants needed.
Protection of participants contributed to the strengths of this study. This study was successful in
listing various nursing implications to benefit the hypertensive patients; however, no clear
implications for future research and gaps in the literature were listed. Moreover, the participants
were not randomly selected (selection bias) and the questionnaires used as tools were not
previously tested (instrumentation). These were threats to internal validity. External validity
was threatened by narrow inclusion criteria, no overweight people, a single geographical locale,
no mention of ethnicity, and a lack of young participants. Furthermore, no theoretical framework
could be found in this article.
A benefit of exercise also appears in Alzheimers disease, proposed by a study done by
Vreugdenhil, Cannell, Davies, and Razay (2011). The studys purpose was to assess the
effectiveness of a community-based exercise program and its effects in improving people with

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Alzheimers. This study was a true experimental design with a sample size of 40 people. For
four months, the experimental group went through the exercise program while the control group
continued with their normal lives. Afterwards, both groups were blindly assessed and results
showed that those who underwent the exercise program had improvements in cognitive function,
physical function, ADL (activities of daily living), depression, and even carer burden.
This study had several strengths. For one, it provided protection of human rights by
receiving informed consent and allowing those in the control group a chance to do the program
once the experiment was over (if they chose to). It gave a thorough explanation of the method,
including each specific step of the experiment and the details of all the standardized tests used
for baseline testing and during assessment. To minimize threats to internal validity, the studys
sample was randomized, every participant was diagnosed with Alzheimers by the same criteria,
and there was a baseline set before the start of program. There was even a pilot study to test
feasibility of the experiment. They used a true experimental design, which controlled other
variables that could have led them to their results (by random sampling and having the assessors
test the participants results blindly). Appropriate statistical tests were used. Last, the study
provided implications for future research and listed multiple limitations to their study, such as the
short period of their experiment (4 months) and the limitation of the study not being double
blinded. However, there were also weaknesses in the study (that the article did not mention) that
need to be taken into consideration. There was no power analysis; therefore the sample size may
or may not have been appropriate. The study was not double-blinded, meaning participants
knew what group they were in, which could have caused them to give biased results (threat to
internal validity). There was a threat to external validity because the sample was chosen from
one particular clinic and participants were only moderately affected by their disease. There was

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no mention of whether or not the experiment was approved by any institutional review board and
there was no apparent theoretical framework.
Haakstad and Bo conducted a research study that focused on the role that regular exercise
played in the prevention of immoderate weight gain during pregnancy and weight retention after
pregnancy (2011). The purpose of the study was to determine whether or not a supervised
aerobic dance exercise program lasting over the course of twelve weeks, with an extra thirty
minutes of moderate exercise on all other non-supervised weekdays, prevents immoderate weight
gain during pregnancy and immoderate weight retention after pregnancy. The design of the
study was an experimental design. The researchers used a sample size of 105 pregnant women.
The women were recruited by health professionals, advertisements that were placed in
newspapers, websites, flyers, and also by word of mouth. The data in the research showed a
positive relationship between regular participation in exercise and decreased weight gain during
pregnancy and decreased weight retention after pregnancy.
There was no theoretical framework mentioned in the study. One strength of the study
was that the researchers identified the limitations of their own study. Another strength of the
study was that it included protection of human participants. The National Committee for
Medical Research Ethics approved the study and a license was given by the Norwegian Social
Sciences Data Services to store and to register each participants health information. A third
strength of the study was that it was an assessor-blinded randomized controlled study. One
limitation of the study was that the dietary habits of the women who participated in the study
were not obtained and this could have affected maternal weight gain as well. Another limitation
of the study was that less than 50 percent of the women who participated in the experimental
group went to 80 percent or more of the exercise sessions that were recommended. Although a

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power analysis was conducted, a threat to internal validity was mortality. In the experimental
group, 19 percent of the women were lost and unable to be examined after intervention. In the
control group, 21 percent of the women were lost and unable to be examined after intervention.
A threat to external validity was that the participants all came from Oslo, Norway. Therefore, the
study was not very representative of all pregnant women. The measures and tools used in the
study were BMI, height, weight using a digital beam scale, and skin fold thickness. There was
an issue with the reliability of the tools used and this is because of the fact participants were
asked to self-report their weight. The study used the t-test and Spearmans rho for their statistical
methods and therefore, appropriate statistical methods were employed.
The aim of the study by Hakkinen et al. (2009) was to compare the health-related quality
of life (HRQOL) of persons at risk for type 2 diabetes to that of the Finnish general population.
In addition, the associations between physical activity and HRQOL of at-risk persons were
studied. One hundred thirty-two at-risk people were recruited from health care centers in Central
Finland. Participants filled out questionnaires including demographic characteristics, HRQOL,
frequency of vigorous physical activity (< or = 2 times a week, once a week, less than once a
week) and comorbidities. HRQOL of at-risk persons differed significantly from that of the
Finnish population in four of the eight dimensions of SF-36. Compared with reference values of
the general population, the values of at-risk persons were worse for general health and pain, but
better for mental health and role limitation (emotional) dimensions. Among at-risk persons,
those physically more active had less depressiveness and lower body weight. HRQOL decreased
linearly with decreasing physical activity in all dimensions.
This research has both strengths and limitations. One of the strengths was that the sample
was 132, which appears appropriate, although no power analysis was done. Generalizability was

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appropriate when it came to age (age ranged from 26 to 73 years), but inappropriate in that it was
comprised of seventy-five percent female and all of the participants were from Finland. Internal
validity was threatened through instrumentation since a self-reported questionnaire was used, and
no discussion was evident on the validity or reliability of the tool. Another threat was selection
bias since the sample was not random. No theoretical framework was noted. No evidence was
noted for protection of human participants. Appropriate statistical tests were used such as
confidence intervals.

Implications for Practice

A home-based walking exercise program appears promising for improving sleep quality
and quality of life for cancer patients and can easily be incorporated into care for those

who are suffering from sleep disturbances.

Schizophrenic patients can choose yoga or aerobic exercise to reduce stress and anxiety

and increase subjective well being as they can be equally effective.

Educate patients with Alzheimers on the benefits of exercise such as improving

cognitive, mental, and physical health.

Nurses should encourage and educate patients about the benefits of walking and

relaxation exercise interventions.

Nurses can teach pregnant women the many benefits of regular exercise.
Both health care professionals and persons at elevated risk for type 2 diabetes should
understand the significance and principles of early intervention of the disease.
Previous studies on the effects of exercise did not include enough randomized controlled

trials about insomnia in cancer patients and stress and anxiety in schizophrenic patients. There
was also a lack of residential exercise programs for Alzheimers patients. The effects of exercise
on pregnancy weight gain and whether health related quality of life was reduced prior to the
onset of diabetes was still not clear. Articles testing the effects of exercise on different diseases
agreed that exercise was beneficial in improving quality of life. The results showed that exercise

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programs had beneficial effects in patients with cancer, hypertension, schizophrenia, and
Alzheimers. Furthermore, regular exercise helped regulate body weight in pregnant women and
diabetic patients. Future research is needed to determine whether exercise helps patients abstain
from drugs and alcohol. In addition, studies would benefit from longer follow up periods.
Teaching patients about the benefits of exercise and encouraging regular physical activity is
important in the field of nursing.

References
Alparslan, G., & Akdemir, N. (2010). Effects of walking and relaxation exercises on controlling
hypertension. Journal of the Australian Traditional-Medicine Society, 16(1), 9-14.

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CDC. (2011). How much physical activity do adults need? Retrieved from
http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html
CDC. (2012). Facts about physical activity. Retrieved from
http://www.cdc.gov/physicalactivity/data/facts.html
Haakstad, L. H., & Bo, K. (2011). Effect of regular exercise on prevention of excessive weight
gain in pregnancy: A randomised controlled trial. European Journal of Contraception &
Reproductive Health Care, 16(2), 116-125. doi:10.3109/13625187.2011.560307
Hakkinen, A., Kukka, A., Onatsu, T., Jarvenpaa, S., Heinonen, A., Kyrolainen, H., Kallinen, M.
(2009). Health-related quality of life and physical activity in persons at high risk for type
2 diabetes. Disability & Rehabilitation, 31(10), 799-805.
doi:10.1080/08916930802354930
Tang, M., Liou, T., & Lin, C. (2010). Improving sleep quality for cancer patients: Benefits of a
home-based exercise intervention. Supportive Care in Cancer, 18(10), 1329-1339.
doi:10.1007/s00520-009-0757-5
Vancampfort, D., De Hert, M., Knapen, J., Wampers, M., Demunter, H., Deckx, S., Probst, M.
(2011). State anxiety, psychological stress and positive well-being responses to yoga and
aerobic exercise in people with schizophrenia: a pilot study. Disability &
Rehabilitation, 33(8), 684-689. doi:10.3109/09638288.2010.509458

Vreugdenhil, A., Cannell, J., Davies, A., & Razay, G. (2012). A community-based exercise

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programme to improve functional ability in people with Alzheimer's disease: A
randomized controlled trial. Scandinavian Journal of Caring Sciences, 26(1), 12-19.
doi:10.1111/j.1471-6712.2011.00895.x

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