Table of Contents
Article critique is important to the application of contributed knowledge because critique facilitates an understanding of content, as well as reliability and validity, or credibility and dependability of an article. A critique of the article ‘higher-intensity exercise results in more sustainable improvements for VO2peak for breast and prostate cancer survivors’ that Martin, Claudio, Battaglini, Hands, and Naumann authored is presented.
The title is good because it offers an overview of the article, including the objective of determining effects of levels of exercise on the peak volume of oxygen consumption. The title also indicates the variables of the study, which are peak volume of oxygen consumption as the dependent variable and levels of intensity of exercise as the independent variable (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
The abstract summarizes, concisely, the main content of the report. It offers summaries of the problem of the study, as the purpose or objective of the study, as well as the methods, results, and conclusion sections. The abstract, however, presented some of the elements of the methods sections, such as design and setting, separately from the methods section (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
Statement of the Problem
The problem is stated, succinctly, and is easy to identify. Even though a sub-title is not offered for the statement of the problem, it is placed at the traditional place that is always at the end of the introductory or the literature review section. The location and the unambiguity make the statement easy to identify. The problem statement also builds a cogent and persuasive argument for the new study. The development of the statement from a review of existing literature identifies a gap in knowledge on the possible role of the intensity of exercise on sustained cardiorespiratory health and the need to bridge the gap. The significance of the gap in the quality of health and the potential significance of the study to an improvement of the quality of life establish the cogent and persuasive qualities of the statement. The problem is also significant to nursing, through its relationship with educator and counselor nursing roles (Kaakinen, Cohlo, Steele, Tabacco, & Hanson, 2014; Martin, Claudio, Battaglini, Hands, & Naumann, 2015) and principles of evidence-based practice.
Hypotheses and Research Questions
No research question is stated, and only one research hypothesis is stated about the three research objectives of the study. The absence of hypotheses on the two other objectives and the absence of research questions on all the objectives are justified because the hypotheses and the questions can be inferred from the objectives. The stated hypothesis had appropriate wordings that identified two conditions and the hypothesized difference between the conditions. The hypothesis is further consistent with the literature review that identifies conflicting knowledge on the role of exercise on respiratory functionality and a gap in knowledge on the effects of different intensity levels of exercise on respiratory functionality. No conceptual framework, however, existed (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
Most of the sources used for the development of the literature review are primary sources, but a majority of the sources are outdated. Only a few of the sources were published with five years of the year of publication of the report. The review, however, offers a state-of-the-art synthesis of evidence on the problem and provides a sound basis, through its identified gap, for the new study (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
Concepts of exercise intensities, exercise mode, and cardiorespiratory functionality are defines, but no conceptual or theoretical framework is offered.
Protection of Human Rights
Appropriate measures were taken to protect the rights of the participants. The study was subjected to the ethical approval of the Human Research Committee of the University of Notre Dame Australia. The approval ensured protection of the participants from harm. The registration of the study with the Australian New Zealand Clinical Trials Registry also ensured compliance, as a precondition for registration, of the procedures with legal requirements for the protection of participants and other stakeholders. In addition, the requirement for the signing of informed consent forms before inclusion of the study ensured the protection of the participants’ right to autonomy that is significant to privacy and confidentiality rights. The study was further designed to minimize risks to the participants while its scope that involved physical activity, especially with the possibility of influencing sustained engagement in physical activities, identifies the likelihood of benefits of the design. The study’s design also collected data at lower cardiorespiratory activity levels than the participants’ peak activity and this addressed possible risks of cardiorespiratory risks of the study (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
The used design, a progressive cohort study design with control and randomization of participants into the treatment groups, was the most rigorous possible design. The design is the most rigorous for subject areas that have not been explored and the literature review identifies the subject of the study as an unexplored. The made comparisons, across a control group and two treatment groups was appropriate for interpreting the effects of exercise and different levels of exercise on cardiorespiratory performance and sustainability of cardiorespiratory fitness and engagement in physical activities. The number of data collection points was also appropriate for the objectives of the study. Data collection at baseline and after weeks of exercise was sufficient for investigating the differences in cardiorespiratory fitness across the control and the two treatment groups while the data collection point at four months after the intervention was sufficient for the determination of sustainability of the induced physical activity effected cardiorespiratory fitness. The design further minimized biases and threats to validity. Blinding of the research participants over the treatment groups to which they were assigned was one of the measures that minimized bias. The allocation of participants to the control and the treatment groups was also based on the participants’ willingness, and this contributed to the reduction of attrition. The objective approach of the study that included objective measures of variables also minimized possible bias (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
Population and Sample
The population of the study is not defined in the methods section, but a definition can be inferred from the objectives of the study. The objective of the study identifies a focus on the population of survivors of breast and prostate cancer. The sample, however, is described in sufficient detail that includes age, diagnosed cancer treatment, treatment for the condition, and the ability to exercise. Power analysis was used in sample size determination, and the used sample size was adequate for the study since it was more than the threshold level for the rejection of the null hypothesis. The proportions of participants across the two demographic factors suggest minimized sampling bias (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
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Data Collection and Measurement
The operational and conceptual definitions are congruent, though no formal method or justification is offered for the definitions. The applied instruments for data collection, such as the International Physical Activity Questionnaire (IPAQ) and the Monark Ergomedic 828E, are described, and their use is consistent with the purpose of the study and the study population. No evidence, however, is presented that the ability of the data collection methods to yield valid and reliable data (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
There were interventions, light-to-moderate intensity exercise, and moderate-to-high intensity exercise, and the report describes them adequately. Information is not offered on the rigor with which the interventions were developed, though the rigor with which they were implemented is described adequately. Almost all of the participants who were allocated to the intervention groups received the intervention, as only four withdrew from the study. There was no training on data collection, but the simplicity and objectivity of the involved procedures identify minimal bias in data collection (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
Analyses were undertaken to address each of the inferred research questions from the research objectives. The first inferred research question related to the changes in cardiorespiratory fitness of breast and prostate cancer survivors due to participation in low-intensity and high-intensity exercises and a repeated analysis of covariance was conducted to investigate changes. The analysis was also applicable to the second research objective that aimed at investigating a difference in the effect of the intensity level of exercise on cardiorespiratory fitness. No analysis, however, was conducted on the third research objective, which related to adverse effects of the intervention. The associated inferred question was addressed through observations. Appropriate statistical methods, analysis of variance and the chi-squared test, were used, depending on the levels of measurement of analyzed variables. No disclosure, however, is made on considerations of the assumptions of the tests and verifications on whether the data satisfied the assumptions. The applied analytical tests controlled for possible confounds and can be assumed to have been the most powerful methods. The type 1 and type 2 errors were avoided using power analysis and the appropriate data analysis tools that controlled for confounds. Intention-to-treat analysis was not conducted in the study and problems of missing values, and their treatments are not disclosed (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
Information about statistical significance is presented on all inferential statistics. Information on confidence intervals is also provided for the descriptive statistics, but no information on effect size is presented on the inferential statistics. An adequate summary of all test statistics, however, is offered in tables that also show statistical significance of the inferential tests. The reported findings lack the sufficient information for facilitating meta-analyses and use in evidence-based studies because of the lack of disclosure on the effect size of the inferential statistics. Even though confidence intervals are offered on descriptive statistics, the objectives of the study are explored through inferential statistics, and the non-disclosure on the relevant effect sizes undermines the reliability of the results for use in meta-analysis or evidence-based practice (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
Interpretation of the Findings
The major findings of the study relate to the changes in cardiorespiratory fitness of the research participants, across and beyond the period of study, and the safety of participation in exercise among survivors of breast and prostate types of cancer. A discussion is made on the results on the effectiveness of the intervention on participants’ cardiorespiratory system and the greater significance of the moderate-to-high intensity exercise to the sustainability of exercise and associated benefits. No discussion, however, is offered on the safety of physical exercise in which the participants engaged. Causal inferences are made on the effects of exercise on improved cardiorespiratory functionality and effects of high-intensity exercise on the sustainability of exercise engagement and improved cardiorespiratory functionality. The inferences are justified through reliance on existing literature and a comparison of the limitations of the study and the scopes of the existing literature sources. The effects of intervention between the treatment groups in the current study, for example, is lower than in the existing literature and the small gap in the intensity of the involved exercises are used to justify this. Similarly, psychological stimulation is used to justify the significance of the higher level of sustained effects of high-intensity exercise that is observed in the study. Even though the interpretations are well founded and are supported by independent literature, they are not consistent with all the limitations of the study. The interpretations factor in the narrow difference in intensity level but do not consider the limitations of non-randomized sampling approach and lack of randomization of participants to control and intervention groups. The report also fails to address issues of generalizability of findings (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
A recommendation is made for a replication of the study with a higher difference in the level of intensity of exercise. The recommendation is reasonable as it relates to the inconsistency in the results of the study, with existing literature, on effects of differences in levels of exercise intensity. Increasing the difference in intensity level is likely to adjust the observed difference towards the values in previous studies. A recommendation for the role of caregivers in promoting physical exercise, especially high-intensity exercises, for better health outcomes is made. Care, however, should be made to ensure that the exercise does not harm clients. The established significance of the interventions and the high-intensity intervention and extent of consistency between the results of the study and previous literature establish reasonability of the implication of the study (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
Presentation and Researcher Credibility
The report is well presented, and its organization facilitates a critical analysis. Each of its sections, which are also outlined systematically, is detailed. The organization of the report that follows the traditional scientific format, including an abstract that offers a succinct summary of the content, also promotes accessibility of the report’s findings for applications in nursing practice. The lack of disclosure for effect sizes of the different analyses, however, undermines the applicability of the accessed findings to nursing practice. The researchers’ academic credentials establish their capacity to conduct a credible study and their professionalism into credible research procedures that include lack of bias and conflict of interest (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
Despite the limitations of the study, of which the non-randomized sampling approach and the lack of disclosure of effect sizes are significant, the study appears to be valid. Consistency between the results of the study and the justified deviation of the results from existing literature establishes the validity. Assuming the validity of the study, it contributes meaningful evidence for evidence-based practice in promoting self-care among survivors of breast and prostate cancers, and possibly other forms of cancer (Martin, Claudio, Battaglini, Hands, & Naumann, 2015).
- Kaakinen, J., Cohlo, D., Steele, R., Tabacco, A., & Hanson, S. (2014). Family health care nursing: Theory, practice, and research, 5th Ed. Philadlphia, PA: F.A. Davis.
- Martin, E., Battaglini, C., Hands, B., & Naumann, F. (2015). Higher-intensity exercise results in more sustainable improvements for VO2peak for breast and prostate cancer survivors. The Oncology Nursing Forum, 42(3), 241-249.