Higher-Intensity Exercise Results in More Sustainable Improvements for VO2peak for Breast and Prostate Cancer Survivors

The Title 

The title of the study is a long one, which means that the authors could have omitted a few words such as ‘more,’ but still conveyed the same meaning. The title of the article does not appear to invite the attraction of readers since it summarizes the findings and conclusions of the research. For example, readers are likely to understand the relationship between intensities of exercising and the peak volume of oxygen consumption (VO 2peak ) without necessarily having to read the article. Therefore, the title should have been adjusted to be less summative than it appears such as, ‘ The Relationship between the Intensity of Exercise and VO 2peak for Breast and Prostate Cancer Survivors.’ Nevertheless, the title of the article is a good one since it summarizes the key variables (high-intensity exercising and Improvements of VO 2peak ). In addition, the title suggests the sample population of the study, which are survivors of breast and prostate cancers. For this case, the title of the article gives readers a view of the central topic of discussion. The authors would also have included the type of study if since there is no indication of the type of journal in which it was published. 

The Abstract 

The abstract of the article is excellent since the authors manage to present the general structure of their article within a few words. Specifically, summarizes the objectives and purposes of the research, gives an outline of the design, the setting, sample size, the methods used, the research variables, findings, conclusions, and the implications for nursing (Martin et al., 2015). The authors avoid the traditional format of writing the abstract, which means that they subdivide this section to give readers a quick view of the structure and organization of their research article. As much as the article’s abstract is that clear, it fails to mention the conceptual frameworks that guided the study in addition to not providing the background to the study including the problem statement. 

The Introduction 

The introduction of the article is clear in setting the motivation of the study. For instance, the authors start by describing the relationship between physical activity among patients of cancer and the risks of development of other infections such as cardiovascular diseases. They note that the treatment procedures associated with this types of infection render the survivors unable to sustain their normal physical activity (Martin et al., 2015). For this reason, they suggest that studying the relationship between intensities of exercising and the sustenance of physical activity was necessary. The introduction, therefore, identifies the gap in research that should be addressed. For instance, they note that, “to optimize an exercise program, research is needed to establish what components of a short-term exercise intervention contribute to sustainable fitness outcomes (Martin et al., 2015) .” 

As much as there is no statement of the problem that the research seeks to address, it is learned that the authors’ objectives are identified from the gap in literature they seek to fill. From this point on, the authors use the identified problem statement to construct a cogent, persuasive argument for their study. The researchers’ description of the gap in literature and the importance of the variables being studied, for example, produce a logical argument, raising the need for nurses to be involved. The paper addresses cancer patients, which is one of the concerns of public health in which the nurses are required to intervene in curbing it. The logical argument staged in the introduction suggests a therapeutic post-medical care for patients that survive breast and prostate cancer. This element of the study, therefore, suggests that the problem that the research seeks to address is an area of nursing concern. Nonetheless, it should be notable that the researchers use relatively new studies in informing their gap in literature, which suggests that the study had a narrowed focus in terms of the period in which post care activities of cancer patients were constantly preferred in nursing. 

The choice by the authors to use the qualitative approach to research was plausible since the nature of the study was comparative between the variables some whose outcomes could not be measured effectively using the quantitative approach. For instance, the effect of exercise on the healthy statuses of the respondents could not have been measured using a quantitative study. The hypothesis of the study was that survivors of the two types of cancer would better sustain their improvement in cardiorespiratory fitness if they engaged in moderate-high intensity fitness programs than when they took part in low-moderate activities (Martin et al., 2015). This hypothesis, therefore, suits the paradigm of the qualitative research approach since it allows for a comparison of the rates of fitness among the different control groups. 

Hypothesis and Research Questions 

The hypothesis of the study is stated clearly within the last paragraph of the introduction. However, it is notable that the researchers do not outline the questions of their study. The absence of the study questions is justified by the presence of three objectives that serve as the study questions. Specifically, the following are the three objectives of the study: 

To study if physical exercise at either a low-to-moderate or moderate-to-high intensity is safe for participants. 

To study if the intensity of workout affected the the preservation of cardiorespiratory fitness and physical activity levels post intervention. 

To compare the cardiorespiratory fitness changes in breast and prostate cancer survivors who participated in a supervised exercise intervention at either moderate-to-high intensity or low-to-moderate intensity (Martin et al., 2015) 

Both the study questions and the hypothesis are framed such that they capture the elements of the key variables. For instance, the main variables from which the objectives and the hypothesis are developed are intensity of exercising and Improvements of VO 2peak. This connection suggests a succinct connection between the framework of the study and its objectives. However, there is a need to note that there is no literature review section, which means that it is not possible to ascertain if the objectives and hypothesis were framed according to extant literature findings of this section. 

Literature Review 

The study being critiqued in this paper does not have a literature review section. The reason that might be given for this occurrence could be attributed to the fact that the researchers were investigating a novel question that could not be supported by extant literature. Therefore, it is not possible to determine whether the studies included for this section are up to date or if they are old. It is also easy and plausible to argue that the researchers do not provide a state-of-the-art synthesis of the secondary evidence on the problem that the researchers seek to address. The option to leave out the literature review section might have worked negatively on the credibility of their findings since extensive reviews of literature are useful tools in the formulation of objectives. The objectives are formed from the gap identified in literature, which means that proving whether the gap in literature that the researchers identified in the introduction is true is not possible. An extensive review of literature is a powerful tool for researchers to compare their findings with what other studies have reported on a specific topic of study. It also implies that this section is useful for confirming the hypotheses of a study since they allow for the comparison of primary findings with what is reported in secondary literature. Overall, it is not possible of the study has a sound basis since it is arguable that it researchers did not research the gap in literature before formulating its objectives. The few studies reviewed in the introduction needed to have reviewed extensively within the literature review section to expand the key words of the abstract and the manner in which they relate to the objectives, hypotheses, and findings of the research. 

The Conceptual and Theoretical Framework 

The first thing that a reader of the research article might note is the absence of a literature review section, which also means that the researchers might have risked missing out on defining the key words established within the abstract. In specificity, the article identified cardiorespiratory exercise test, aerobic exercise, breast neoplasms, and prostate neoplasms as the key words for the study. However, the researchers do not proceed to describe what each of them means. In fact, there is only a mention of some of them within the introduction and within the rest of the paper without a description of what they mean and how useful they would be to the study. This factor could be attributed to the fact that the paper lacks an extensive review of literature that could have helped in such descriptions. In addition, the introduction of the paper is too short to have accommodated all the definitions related to the key words. Nevertheless, the absence of such definitions does not affect the meaning of the paper since the conceptual terms are included in the rest of the paper in a manner that is easy to understand. It means that the authors weave the conceptual terms into the framework of the study such that they are almost self-explanatory. The research paper additional lacks both a conceptual and theoretical framework. For instance, the authors do not describe with theoretical framework guided their methodological. In addition, there is no framework that the researchers would be used in defining the results of the data collection. The absence of a theoretical framework, however, is justifiable for the fact that researchers did not include a literature review section that would have explained their rationale for adopting the specific theoretical or conceptual framework, as they would have. 

Methodology 

The University of Notre Dame Australia Human Research Ethics Committee (study #011024F) approved the research project undertaken by the researchers (Martin et al., 2015). In addition, the research was registered under the Australian New Zealand Clinical Trials Registry (ACTRN12611000436976) as well as the Australian Cancer Trials Registry (Martin et al., 2015). The participants of the study were recruited after letters of consent were issued to them and they returned. Such efforts meant that the researchers strived to attain a high level of respect for ethics of researching using human samples. The researchers ensured that they maximize the benefits of the respondents and minimize risks by using self-reported levels of fitness exercising intensity (Martin et al., 2015). This means that the respondents were not required to adopt the levels of intensity that would not suit their standards of daily living. This move was useful since it did not expose the respondents to dangerous levels of physical exercise intensity. 

The research employed the most rigorous design possible for its objectives. For instance, there was a determined criterion for inclusion, which ensured that only respondents of a given required characteristic were included. Specifically, the only respondents that had undergone treatments for breast and prostate cancer were recruited to the study. The article gives an extensive participant flow chart, which indicates the different stages during which the 222 potential respondents were filtered to remain with the final 32 for the data collection. The design also allowed for rigorous data analyses using statistical tools such as ANOVAs and others. The study used a control group of respondents who carried on their routine physical activity for the entire period that the research was conducted. This group of participants is those that did not consider the levels of intensity that was the subject of the study. 

Data from the participants was collected at different points based on the facility to which they were recruited for inclusion as well as the time during which they were available. This move ensured that the respondents reported to the researchers at their convenience. However, the duration required for each complete data collection process hindered the collection of data from a large number of participants. As much as the data collection points were suitable for the nature of the study, it should be understood that the article does not elaborate how it treated biases in the information so collected considering that the intensity levels of training were self-reported as indicated. 

The article further describes the sample of respondents from which the data was collected and how they were recruited. For example, data was collected from a sample of 32 respondents who were recruited from different facilities of cancer treatment from around Australia. The study describes the criteria for their inclusion, noting that they only qualified if they had undergone screening and subsequent treatment of their ailments. Furthermore, the random sampling technique was used in recruiting participants, which ensured that they had an equal chance of being used in the collection of data. 

During the collection, the researchers do not indicate how they operationalized the conceptual and theoretical framework since they were not obliged to do so for lack of one. However, they operationalize the variables through comparing the effectiveness of the different intensities of exercising with patient outcomes in terms of the sustenance of cardiovascular resilience. They also compare the results from each category of exercise intensity with those from participant that had their normal exercises carried out during the period of the research. However, there was no intervention reported in the methodology and data collection since it was not required. Data was also collected in ways that minimized bias since the researchers collected information directly from their respondents without using other personnel. It means that the researchers were able to record first-hand information that had not been interfered with by personal judgments that would have been possible had they used third parties. The only source of bias in the collected data would be the fact the researchers relied on reported data from the respondents instead of measuring it themselves. 

Results 

The researchers undertake sufficient analyses of the results to test the hypothesis that they had formulated earlier. For instance, they use the ANOVA tests to determine the relationship among each of the variables of the study that was used in the formulation of the hypothesis. In addition, the study employed the Pearson chi-square tests in the analysis of categorical variables. ANOVAs and the Pearson chi-square tests were considered the best statistical tests for analyzing the relationship between each of the variables and their relevance to the study question. It is also reported within the study that the researchers used the SPSS version 20 as the statistical tool in the analysis of the data. during the analysis of data, the researchers set the statistical significance a priori at p < 0.05 (Martin et al., 2015). They additionally generated descriptive statistics for the variables used in the formulation of the hypothesis. Therefore, the researchers used the most powerful methods of data analysis that was effective in controlling for the confounding variables. However, there is a need to note that the researchers did not mention or describe how they dealt with type I and II errors in their research. This issue could be attributed to the fact that they only had one hypothesis, which they tested using the analysis of data and confirmed in the discussion section. 

The researchers performed interventions to treatment in which they tested the effects of physical exercise on the rates of ventilation among the study respondent groups. In this intervention, they wanted to establish if physical exercise was a good intervention for the improving, the health outcomes of the people involved. After that, they compared the effects of the intensity of such exercise to the effectiveness of ventilation among the research’s respondents. It is also noteworthy that the study does not mention how it addressed the missing values during the analysis of the data. 

Findings 

The study presents information concerning the statistical significance of each of the variables that were studied. They wanted to establish the effects of exercising on the health outcomes of the respondents as well as the effect of that of the intensity of the same exercise on the respondents’ health statuses. For example, they note that physical exercise has a statistical significance with the health statuses of the respondents. In addition, they find and report that the health outcomes have a stronger statistical significance with medium-high intensity exercising than low-medium intensity exercising. Furthermore, the researchers summarize the findings of their investigations using tables and percentages. They follow these summarizations with adequate descriptions of the effects of each of the study variables they had investigated. The results are also presented in a manner that is sufficient to enable a meta-analysis and it provides sufficient information for an EBP. 

Discussion 

The investigators venture into interpreting all their major findings by basing their interpretation of such results on previous studies. It should be noted, however, that the studies used in such an interpretation do not have a direct relationship with what the study sought to investigate. For instance, the studies were different in terms of their respondents and hypotheses. Nevertheless, the investigators find a correlation between their findings and what was reported within extant literature. Of critical importance to note in this interpretation is the fact that a lack of a conceptual framework during the study meant that the findings were not analyzed and according to such frameworks. For such a reason, all the interpretations of the data are well founded because the researchers conducted rigorous data analyses and compared the findings with extant literature. The researchers also addressed the issue of generalizability of findings by collecting data from control groups as well as from the study groups of respondents. It is also imperative to note that the researchers indicate that their findings could inform the strategies of clinical nursing by insisting the importance of physical exercise on the improvement of cardiorespiratory outcomes for patients that suffer from the two types of cancer studied. 

Global Issues 

The report is systematically organized with sections and subsections that facilitate a smooth transition from one idea to another. Specifically, there is the abstract, the introduction, methodology, results and analysis, discussion, and conclusion. In the methods section of the paper, the researchers give a CONSORT flow chart of the respondents, which shows the manner in which such participants were recruited for the data collection process. In addition, the report was written in a way that facilitates the accessibility of the findings by practicing nurses since the findings are elaborated in the distinctive section that is then followed by a section defining the implications of such findings to nursing practice. The study also promotes credibility of the findings since the researchers used a comprehensive methodology in addition to data analysis and interpretation. For this reason, despite the limitations of the study, its findings appear to be valid because of the rigorous analyses and comparison with extant literature. The research, therefore, contributes to existing body of knowledge on the therapeutic management of breast and prostate cancers through provision of an evidence-based framework of such management. 

Reference 

Martin, E. A., Battaglini, C. L., Hands, B., & Naumann, F. (2015, May). Higher-intensity exercise results in more sustainable improvements for VO2peak for breast and prostate cancer survivors. In  Oncol Nurs Forum  (Vol. 42, No. 3, pp. 241-9).