Effectiveness of Aerobic Exercise on Ambulatory Blood Pressure in Hypertensive Patients
Effectiveness of Aerobic Exercise on Ambulatory Blood Pressure in Hypertensive Patients
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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
Physical exercise may improve hypertension and minimize cardiac complications. At the project site there were no standardized guidelines for hypertensive patients utilizing aerobic exercise as a blood pressure (BP) management mechanism, so an evidence based solution was sought. 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. Dorothy Orem’s self-care deficit theory and Kurt Lewin’s change model provided the scientific underpinnings for the project. Data were retrieved from the clinic’s electronic medical records on adult hypertensive patients ( N=10) and compared at baseline and four weeks post implementation. A paired-sample t-test showed a statistically and clinically significant improvement in systolic BP from baseline ( M = 152.60, SD = 14.42) to four weeks post implementation ( M = 126.10, SD = 19.93), t (9) = 6.35, p = .001. A paired-sample t-test also showed a statistically and clinically significant decrease in the mean diastolic BP level from baseline ( M = 87.30, SD = 11.19) to four weeks post implementation ( M = 78.10, SD = 8.45) , t (9) = 2.56, p = .031. Based on the results, the translation of Saco-Ledo et al.’s research on aerobic exercise may impact blood pressures in this population. Recommendations include sustaining the project and disseminating the results.
Keywords: aerobic exercise, ambulatory blood pressure, Saco-Ledo et al.’s research on aerobic exercise, Dorothy Orem’s self-care deficit theory, hypertension, hypertension-related conditions, Kurt Lewin’s change model, evidence based practice.
I dedicate this project to God, my life’s author and finisher. Irrespective of the unsurmountable challenges and moments of despair, your mercy, grace, and love lead me through. Without your divine wisdom, Almighty father, I would not have been here this day. To my beloved families here and abroad, my mum, siblings, cousins, and spouse Engr. G. O. Pamugo, I achieved this goal because of your fervent prayers, support, and encouragement that fortified my strength, endurance, perseverance, and resilience not to quit to frustrations and fears. Even with my poor health, I struggled and still made it to this day because you all held my weak parts as I journeyed and ran the race to success. Thank you for believing in me and investing in my success. God bless you all. To my dad-late Chief M.E. Chukwu, I did accomplish your dreams on me, and I know wherever your soul is at this time, it is full of joy; rest in peace, daddy, until we meet again.
To my elder brother in the Lord, Rev. Fr. C. Iwuagwu, words cannot express the magnitude of gratitude I owe you for your fatherly and brotherly love, belief in my abilities, countless hours of encouragement, enormous -uplifts, and renewed determination. You are a blessing and gift to our family; remain blessed.
Acknowledgments
The fruitful journey of the Doctor of Nursing program (DNP) was made possible by the unconditional support of extraordinary and cherished individuals, such as Dr. Khoa and Don Nguyen, MD, for serving as my preceptor/mentor throughout the stages of my direct immersion project. I want to thank Dr. Dawn Robinson (Faculty /Chair), for her unshaken patience, quick feedback, and radiant positive energy, together with Dr. Sandi McDermott and faculty in course level review, reading countless revisions and providing knowledgeably expert guidance to the end of this course.
To my colleagues, Jeffrey Souza, Tresa Antony, Mercy Daniel, Lisa Johnson, Marissa Rafael, and Skyler Meyer, thank you for your unfading support. Countless times, I felt like the world has collapsed upon me, desperately seeking the way out in the darkness; lo and behold, your torchlights point through the doors of escape. I recognized each day we journeyed that the race was worth it because you all were there pointing your lights to the proper outlet.
To my supportive friends, Sr. Onyinyechukwu Uba, Ms. Euphemia, Ms. Amaka, Dr. Bashiru, Calista, Sylvia, Vincent, and Ogunbayode. Thank you for your support, encouragement, love, and understanding, especially in moments of desolation, sequestration, and poor communication from me due to loads of assignments on my table.
To my preceptees, Vivian, Michael, Adaeze, Jane, Kate, Esther, Marybeth, Florence, Ubong, Nkele, and others, your understanding when I transferred my frustrations to you humbled me most in my relationship with you as a preceptor. Looking upon the “role model thing” was the driving force that propelled me to this finishing point. You are more than welcome anytime for more guidance in the future in your further studies.
During this program, I also worked on my post-graduate certification program in the psychiatric mental health nurse practitioner program, and this is where I thank Dr. Ghislaine Mogo, my preceptor, for her tremendous patience and support. To my spiritual family, the Daughters of Charity of the Most Precious Blood, God gave me the best opportunity to be among you. Mother Ofelia Marzocca, see what I have become this day because of your decisions in the most challenging moments of my life and humble expression of an arduous journey that would benefit all. Thank you all, and may God reward us according to our deeds.
Table of Contents Chapter 1: Introduction to the Project 1 Background of the Project 2 Problem Statement 3 Purpose of the Project 4 Clinical Question 7 Advancing Scientific Knowledge 7 Significance of the Project 10 Rationale for the Methodology 11 Nature of the Project Design 12 Definition of Terms 13 Assumptions, Limitations, Delimitations 15 Summary and Organization of the Remainder of the Project 17 Chapter 2: Literature Review 19 Theoretical Foundations 22 Review of the Literature 25 Prevalence of Hypertension 26 Aerobic Exercise Health Intervention 31 Effect of Exercise on Blood Pressure 34 Summary 39 Chapter 3: Methodology 41 Statement of the Problem 42 Clinical Question 43 Project Methodology 44 Project Design 45 Population and Sample Selection 47 Instrumentation and Sources of Data 48 Validity 49 Reliability 50 Data Collection Procedures 50 Data Analysis Procedures 52 Potential Bias and Mitigation 53 Ethical Considerations 54 Limitations 55 Summary 55 Chapter 4: Data Analysis and Results 58 Descriptive Data 59 Data Analysis Procedures 60 Results 61 Summary 63 Chapter 5: Summary, Conclusions, and Recommendations 65 Summary of Findings and Conclusion 68 Implications 70 Theoretical Implications 70 Practical Implications 72 Future Implications 73 Recommendations 73 Recommendations for Future Projects 74 Recommendations for Practice 75 References 77 Appendix A 93 Grand Canyon University Institutional Review Board Outcome Letter 93 Appendix B 94 Saco-Ledo et al.’s Research Article 94 Appendix C 95 Permission to Use Saco-Ledo et al.’s Research Article 95
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