Description
For the first template in week 6, you will choose either a Qualitative or a Quantitative Review (Please do not complete both Quantitative and Qualitative Appraisal). Your second article is a Systematic Review Appraisal. Make sure you receive approval from your instructor in week 4 for the article you use to complete either the Qualitative or Quantitative Review and for the Systematic Review. There are hyperlinks to these templates in the week 6 instructions. Do not create your own document with answers.Each section of the template is required to be completed as this assignment builds on your Evidence-Based Practice Project. Each template has a citation that must be submitted in APA format. Answers to questions in Synopsis sections are required (see template examples in your book). Each question must have an answer of 1-2 full sentences in length per question. Credibility section Yes/No answers are also required. The Comments area is also required and should be at least 1-3 sentences noting how this article relates to your nursing issue topic from week 3 and what you thought was significant.You will be using these articles again in your week 9 Evidence-Based Practice Project Poster.Please review the rubric closely and proof your work by reviewing instructions before you submit.Note: Please include a PDF or Word copy of your approved article from Week 4 with your submission.The chosen topic and PICOT will be used for your Week 9 poster assignment. It guided your article searches in Week 4 which are to be used in completing your appraisals in Week 6.
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APPENDIX F
Appraisal Guide
Findings of a Quantitative Study
Citation:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Synopsis
What was the purpose of the study (research questions, purposes, and hypotheses)?
How was the sample obtained?
What inclusion or exclusion criteria were used?
Who from the sample actually participated or contributed data (demographic or clinical profile
and dropout rate)?
What methods were used to collect data (e.g., sequence, timing, types of data, and measures)?
Was an intervention tested?
Yes
No
1. How was the sample size determined?
2. Were patients randomly assigned to treatment groups?
What are the main findings?
Credibility
Is the study published in a source
that required peer review?
Yes
No
Not clear
*Did the data obtained and the
analysis conducted answer the
research question?
Yes
No
Not clear
Were the measuring instruments
reliable and valid?
Yes
No
Not clear
*Were important extraneous
variables and bias controlled?
Yes
No
Not clear
*If an intervention was tested,
answer the following five questions:
Yes
No
Not clear
Brown
APP F-1
1. Were participants randomly
assigned to groups and were
the two groups similar at the
start (before the intervention)?
Yes
No
Not clear
2. Were the interventions well
defined and consistently
delivered?
Yes
No
Not clear
3. Were the groups treated
equally other than the
difference in interventions?
Yes
No
Not clear
4. If no difference was found, was
the sample size large enough
to detect a difference if one existed?
Yes
No
Not clear
5. If a difference was found, are
you confident it was due to the
intervention?
Yes
No
Not clear
Are the findings consistent with
findings from other studies?
Yes
Some
No
ARE THE FINDINGS CREDIBLE?
Yes All
Yes Some
Not clear
No
Clinical Significance
Note any difference in means, r2s, or measures of clinical effects (ABI, NNT, RR, OR)
*Is the target population clearly
described?
Yes
No
Not clear
*Is the frequency, association, or
treatment effect impressive enough
for you to be confident that the finding
would make a clinical difference if used
as the basis for care?
Yes
No
Not clear
ARE THE FINDINGS
CLINICALLY SIGNIFICANT?
Yes All
Yes Some
No
* = Important criteria
Comments
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
APP F-2
Brown
APPENDIX F
Appraisal Guide
Findings of a Quantitative Study
Citation:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Synopsis
What was the purpose of the study (research questions, purposes, and hypotheses)?
How was the sample obtained?
What inclusion or exclusion criteria were used?
Who from the sample actually participated or contributed data (demographic or clinical profile
and dropout rate)?
What methods were used to collect data (e.g., sequence, timing, types of data, and measures)?
Was an intervention tested?
Yes
No
1. How was the sample size determined?
2. Were patients randomly assigned to treatment groups?
What are the main findings?
Credibility
Is the study published in a source
that required peer review?
Yes
No
Not clear
*Did the data obtained and the
analysis conducted answer the
research question?
Yes
No
Not clear
Were the measuring instruments
reliable and valid?
Yes
No
Not clear
*Were important extraneous
variables and bias controlled?
Yes
No
Not clear
*If an intervention was tested,
answer the following five questions:
Yes
No
Not clear
Brown
APP F-1
1. Were participants randomly
assigned to groups and were
the two groups similar at the
start (before the intervention)?
Yes
No
Not clear
2. Were the interventions well
defined and consistently
delivered?
Yes
No
Not clear
3. Were the groups treated
equally other than the
difference in interventions?
Yes
No
Not clear
4. If no difference was found, was
the sample size large enough
to detect a difference if one existed?
Yes
No
Not clear
5. If a difference was found, are
you confident it was due to the
intervention?
Yes
No
Not clear
Are the findings consistent with
findings from other studies?
Yes
Some
No
ARE THE FINDINGS CREDIBLE?
Yes All
Yes Some
Not clear
No
Clinical Significance
Note any difference in means, r2s, or measures of clinical effects (ABI, NNT, RR, OR)
*Is the target population clearly
described?
Yes
No
Not clear
*Is the frequency, association, or
treatment effect impressive enough
for you to be confident that the finding
would make a clinical difference if used
as the basis for care?
Yes
No
Not clear
ARE THE FINDINGS
CLINICALLY SIGNIFICANT?
Yes All
Yes Some
No
* = Important criteria
Comments
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
APP F-2
Brown
5.4
Article
Effect of High-Intensity Interval
Training on Quality of Life, Sleep
Quality, Exercise Motivation and
Enjoyment in Sedentary People
with Type 1 Diabetes Mellitus
Jesús Alarcón-Gómez, Iván Chulvi-Medrano, Fernando Martin-Rivera and Joaquín Calatayud
Topic Collection
Sports Medicine and Physical Fitness
Edited by
Dr. Ewan Thomas, Prof. Dr. Elvira Padua and Prof. Dr. Ivan Chulvi-Medrano
https://doi.org/10.3390/ijerph182312612
International Journal of
Environmental Research
and Public Health
Article
Effect of High-Intensity Interval Training on Quality of Life,
Sleep Quality, Exercise Motivation and Enjoyment in Sedentary
People with Type 1 Diabetes Mellitus
Jesús Alarcón-Gómez 1 , Iván Chulvi-Medrano 2 , Fernando Martin-Rivera 3, * and Joaquín Calatayud 4
1
2
3
4
*
Citation: Alarcón-Gómez, J.;
Chulvi-Medrano, I.; Martin-Rivera, F.;
Calatayud, J. Effect of High-Intensity
Interval Training on Quality of Life,
Sleep Quality, Exercise Motivation
and Enjoyment in Sedentary People
with Type 1 Diabetes Mellitus. Int. J.
Environ. Res. Public Health 2021, 18,
12612. https://doi.org/10.3390/
ijerph182312612
Academic Editor: Paul B. Tchounwou
Received: 30 September 2021
Accepted: 25 November 2021
Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain;
jesusadol18@gmail.com
UIRFIDE Sport Performance and Physical Fitness Research Group, University of Valencia,
46010 Valencia, Spain; ivan.chulvi@uv.es
Research Group in Prevention and Health in Exercise and Sport, University of Valencia, 46010 Valencia, Spain
Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy,
University of Valencia, 46010 Valencia, Spain; joaquin.calatayud@uv.es
Correspondence: fernando-martin.rivera@uv.es or fernando.martin-rivera@uv.es
Abstract: (1) Background: Type 1 diabetes mellitus (T1DM) people’s health-related quality of life
(HRQoL) is affected by glycemic control. Regular exercise is strongly recommended to these patients
due to its cardiovascular and metabolic benefits. However, a large percentage of patients with
T1DM people present a sedentary behavior because of the fear of a post-exercise hypoglycemia
event, lack of time, lack of motivation and the complicated management of exercise, glycemic and
insulin dose interaction. High-intensity interval training (HIIT) is an efficient and safe methodology
since it prevents hypoglycemia and does not require much time, which are the main barriers for
this population to doing exercise and increasing physical conditioning. (2) Methods: Nineteen
sedentary adults (37 ± 6.5 years) with T1DM, were randomly assigned to 6 weeks of either HIIT
(12-16-20 × 30-s intervals interspersed with 1-min rest periods) performed thrice weekly, or to the
control group, which did not train. HRQoL, sleep quality, exercise motivation and enjoyment were
measured as psychological variables. (4) Results: HRQoL improved in physical and social domains,
PF (1.9%); PR (80.3%); GH (16.6); SF (34.1%). Sleep quality improved in the HIIT group by 21.4%.
Enjoyment improved by 7% and intrinsic motivation was increased by 13%. (5) Conclusions: We
suggest that the 6-week HIIT program used in the present study is safe, since no severe hypoglycemia
were reported, and an effective strategy in improving HRQoL, sleep quality, exercise motivation and
enjoyment which are important psychological well-being factors in T1DM people.
Keywords: diabetes type 1; HIIT; sleep quality; exercise motivation; quality of life
Published: 30 November 2021
Publisher’s Note: MDPI stays neutral
with regard to jurisdictional claims in
1. Introduction
published maps and institutional affil-
Type 1 diabetes mellitus (T1DM) is a chronic metabolic disorder characterized by the
insufficient production of endogenous insulin due to pancreatic beta cells autoimmune
destruction which is associated with multiple clinical manifestations [1]. Reports from
the International Diabetes Federation and the World Health Organization suggest that
25–45 million adults (>20 years old) suffer from T1DM worldwide [2]. Furthermore, it is
estimated that the number of people with T1DM will increase by 25% by 2030 [2,3].
T1DM generates several negative consequences affecting health-related quality of
life (HRQoL) [4]. For instance, frequent self-monitoring of blood glucose, worry about
hypoglycemia and lifestyle changes management derived from the disease increase stress
situations, depression, anxiety and fear [5,6]. In addition, sleep quality (a determinant
factor in glycemic control and physical and mental well-being) is decreased among T1DM
patients, with shorter sleep duration and more episodes of apnea than healthy people [7].
iations.
Copyright: © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Int. J. Environ. Res. Public Health 2021, 18, 12612. https://doi.org/10.3390/ijerph182312612
https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2021, 18, 12612
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Treatment of T1DM requires a rigorous balance among diet, physical activity and
exogenous insulin administration to maintain blood glucose in normal ranges [8]. From all
these factors, exercise is commonly known as an essential tool to improve HRQoL among
those with T1DM [9]. However, exercise has shown some negative effects on sleep quality
in this population due to the increase of exercise-induced nocturnal hypoglycemia [6].
T1DM people are mostly sedentary due to, mainly, the following reasons: (a) fear of
hypoglycemia, (b) lack of time and (c) lack of motivation [10–12]. Given this background,
new exercise methods eliciting enjoyment and motivation are needed to increase adherence,
and consequently, improve HRQoL of T1DM people, helping to avoid sleep disturbances.
Thus, the aforementioned barriers that T1DM people face might be overcome with highintensity interval training (HIIT). This training method involves repeated brief bouts of high
intensity (>85% VO2 max) intermitted with passive or active recovery periods, requiring
lower exercise duration than moderate-intensity continuous training (MICT) [13,14]. In
addition, HIIT also prevents hypoglycemic events, typical of MICT, due to its anaerobic
predominance, avoiding nocturnal hypoglycemia as well [12]. There is also evidence to
suggest that HIIT elicits at least the same psychological effects, including enjoyment, as
MICT among healthy and pathologic populations such as obesity, Type 2 diabetes and
cardiovascular disease [15–18]. However, there are no studies investigating its possible
application to improve psychological well-being and exercise adherence in T1DM people.
The safety and time efficiency of HIIT make this exercise method an interesting alternative
for this population. So far, HIIT was only applied in T1DM people to analyze the long-term
effects in aerobic capacity and glycemic control [19–21]. Therefore, the aim of this study
was to analyze the effect of HIIT on variables that influence psychological well-being in
T1DM individuals, previously inactive.
2. Materials and Methods
2.1. Participants and Research Design
Nineteen sedentary adults clinically diagnosed as T1DM (10 males and 9 females)
from the Valencian Diabetes Association (VDA) and social media announcement were
selected to be part of the sample (Table 1). The following inclusion criteria were set: (1) aged
18–45 years, (2) duration of T1DM > 4 years, (3) HbA1C < 10% (4) no structured exercise
training programs in the previous 6 months, (5) no known comorbidities related or not
to diabetes. Smoking regularly, taking any medication that affects heart rate, suffering
overweight or obesity and having planned major surgery were adopted as exclusion criteria (Figure 1). The institutional gym was the lab where all the activities were conducted.
Participants were informed of the purposes and risks involved in the study before giving
their informed written consent to participate. Furthermore, they completed two questionnaires before the beginning of the measurement protocols: the PAR-Q to assess participants’
level of risk to safely participate and the IPAQ (short version), to ensure the previous
sedentary behavior of the subjects. All the procedures were developed in accordance with
the principles of the Declaration of Helsinki and were approved by the local Institutional
Review Board (H1421157445503).
Table 1. Participants.
HIIT (n = 11)
Age (years)
Sex (male/female)
Duration of T1DM (years)
BMI (kg/m2 )
HbA1 (mmol/mol)
VO2 max. (mL/min/kg)
Control (n = 8)
Pre
Post
Pre
Post
38 ± 5.5
6 m/5 f
20.58 ± 8.4
25.1 ± 0.4
58.1 ± 15.3
37.1 ± 4.1
24.9 ± 0.6
54.9 ± 11.6
40.4 ± 3.8
35 ± 8.2
4 m/4 f
21.16 ± 6.5
25.2 ± 0.8
59.1 ± 10.1
37.0 ± 5.5
25.3 ± 0.6
59.3 ± 9.5
37.2 ± 5.1
‐
‐
‐
‐
Int. J. Environ. Res. Public Health 2021, 18, 12612
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Figure 1. Shows the recruitment process.
This is a randomized controlled trial with parallel design in which the eligible subjects were randomly allocated by the researchers (www.randomizer.org, accessed on
2 January 2019) to the experimental or to the control group, and classified by gender
to ensure a balanced number of men and women in each group. They all were asked to
maintain their habitual diet and not to exercise outside of the study.
2.2. Measures
All tests were completed online before starting the experimental period and after the
last training‐session with a previous period of instruction to the participants to ensure the
total comprehension
of the questionnaires which were
‐
‐ used. Nonetheless, patients were
instructed to ask any doubt
‐ that might arise to the investigators while the questionnaires
‐
were being completed. All the procedures were exactly conducted in the same way
both times.
‐
‐
2.2.1. Health-Related Quality of Life
Health-related quality of life (HRQoL) was self-reported by completing the short form
36 health survey (SF-36) [22]. This questionnaire is a valid and reliable generic instrument
to assess HRQoL and its components [23,24]. This questionnaire contains 36 questions
including an eight-domain profile of functional health and well-being scores (physical
functioning, role limitation due to physical problems, bodily pain, general health, vitality,
social functioning, role limitation due to emotional problems and mental health). For each
parameter, scores are coded, summed and transformed to a scale from 0 (the worst possible
condition) to 100 (the best possible condition) [25,26].
2.2.2. Sleep Quality
Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI), a clinical
sleep-behavior questionnaire that has been validated for use in patients with different
chronic diseases and the general population [27,28]. The PSQI is an instrument that aims
to measure subjective sleep quality and related disorders and involves seven domains:
Int. J. Environ. Res. Public Health 2021, 18, 12612
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(i) subjective sleep quality (very good to very bad), (ii) sleep latency (≤15 min to >60 min),
(iii) sleep duration (≥7 h to
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