Running head: QUANTITATIVE RESEARCH ARTICLE CRITIQUE
Quantitative Research Article Critique
Candi Duenas
Nevada State College
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Research Problem
Sedentary behavior and daily physical activity (PA) level is a problem for cardiac patients, as a lessened
activity level may be a strong predictor of mortality in this population. The significance of this research is
documented in this literature. For many older adults, coronary artery disease negatively impacts their ability to
perform activities of daily living and effects their independence, but regular exercise can help these patients
maintain their functional capabilities. This research provides nurses with education on how they can help their
patients understand the importance of being active and avoiding a sedentary lifestyle (Buijs et al., 2015, p. 10).
Purpose and Method
The purpose of this study is clearly stated in the abstract of this article. The purpose of this study is to
“assess sedentary behavior and the quantity and quality of daily PA among older cardiac patients who were at
different stages of recovery following a cardiac event” (Buijs et al., 2015, p. 10). A cross-sectional design and a
convenience sampling technique was used. For the purpose of this study cross-sectional design and convenience
sampling is appropriate. Data was collected at the same time and participants were easy to access. The textbook
agrees that in cross-sectional study design researchers gather data from a group of subjects at only one point in time.
Cross-sectional designs provide a snapshot by collecting data about the independent variable and dependent variable
at the same time (Schmidt & Brown, 2019, p. 163). “Convenience sampling is seen in many nursing studies because
of the ease of data collection” (Schmidt & Brown, 2019, p. 296). The design section of the article clearly states that
in this study the dependent variables are the steps taken per day and time subjects spend sedentary. Steps per day is
categorized as either light or moderate to vigorous PA. Although it is not clearly stated in the article, the variable
being manipulated (the independent variable) is the cardiac rehab status. The researchers split the sample into three
groups: (a) Rehab, (b) Maintain, and (c) Acute.
Literature review
The literature review is found in the background portion of the article which summarizes the existing
literature on the topic of coronary artery disease patients and the significance of PA. The authors discuss evidence
that suggest that to achieve the health benefits associated with PA, individuals older than age 60 years and those
with coronary artery disease should strive to accumulate more than 6,500 steps per day for optimal cardiovascular
health. Furthermore, it is recommended as a secondary prevention guideline that cardiac patients should accumulate
150 minutes of moderate to vigorous PA each week in bouts lasting more than ten minutes. The researchers are of
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opinion that nurses should seek to gain a thorough understanding of the habitual daily PA of their patients and their
sedentary behavior, and counsel their patients on the importance of having cardiovascular fitness (Buijs et al., 2015,
p. 11). The article does provide up-to-date evidence because it used twenty references which were within five years
of the publication date.
Sample
The criteria and methods used to select a representative and unbiased sample was using the rule of 30 for an
adequate sample size to decrease sampling bias, using inclusion and exclusion criteria to have a more homogeneous
sample, and the use of power analysis. Convenience sampling was used to recruit 96 participants for this study.
Sampling bias is a possibility with convenience sampling, so researchers choose inclusion criteria to determine a
representative sample (Schmidt & Brown, 2019, p. 295). Inclusion criteria are guided by the research question and
careful identification of the of the target and accessible populations, they determine what subjects will be in the
study to avoid sampling error. Inclusion criteria for this study was that participants had to have a primary diagnosis
of coronary artery disease, be medically stable, be receiving optimal medical therapy, had to be within the ages of 60
to 85, and had to be able to participate in exercise. The requirement for the Acute group was that they had to have
recently had a cardiac event or surgical intervention and were about to start a cardiac rehabilitation program. The
Rehab group consisted of participants who had recently completed a cardiac rehabilitation program. The Maintain
group was composed of participants who had completed a cardiac rehabilitation program more than one year ago but
self-reported that they were still physically active. Our study does not mention exclusion criteria, yet many
researchers utilize it to determine what characteristics will not be included in the study to decrease the risk of having
variables that will influence the results of the study (Schmidt & Brown, 2019, p. 287-288). Another method to insure
an adequate sample size is to increase the number of subjects. The rule of thirty is used by many researchers. This
rule states that to have a sufficient sample size, there should be a minimum of 30 subjects in each group being
studied. An effective method to determine sample size for quantitative studies is to use power analysis (Schmidt &
Brown, 2019, p. 300). Using power analysis and the rule of 30 were used by the researchers to obtain an adequate
sample size. For this study a level of significance was set at 0.05 with a power of 0.80. All participants provided
written informed consent and the study was approved by the university’s human research ethics board.
Data Collection and Analysis
QUANTITATIVE RESEARCH ARTICLE CRITIQUE
A six-minute walk test was completed (following the American Thoracic Society guidelines) to assess
subject’s exercise capacity when walking a distance up to 490 meters. For the Acute and Rehab group this test was
conducted at the Cardiac Rehabilitation facility at the hospital. The Maintain group tested at a community-based
facility where they exercised. Daily PA was assessed using the SenseWear Mini Armband. Data were used to
provide information on the subject’s number of steps per day, energy expenditure, and time spent at different
intensities of PA (sedentary, light, or moderate-vigorous physical activity) with the exclusion of sleep data. The
researchers also inspected the data to determine the time spent in planned continuous and spontaneous moderate to
vigorous PA. If activity was classified was classified as “planned continuous” PA had to last for longer than ten
minutes bouts at a metabolic equivalent rate 3.0 or higher. Activity less than ten-minute intervals was counted as
“spontaneous moderate to vigorous activity.” The tools used to measure the independent variable (cardiac rehab
status) were the six-minute walk test and the SenseWear Mini Armband. The armband was worn for four
consecutive days with a minimum of one weekend day. The average of the three full days was used and data was
only collected when the armband was worn for more than ninety-five percent of the day. Sedentary time was
measured as waking time with an energy expenditure less than 1.5 metabolic equivalents. Time spent in light PA
consisted of minutes where activities yielded an energy expenditure of 1.6 to 2.9 metabolic equivalents. Time spent
in moderate to vigorous PA included each minute where the activity resulted in an energy expenditure of more than
3.0 metabolic equivalents. Our textbook states that in cross-sectional studies data is collected on the group of
subjects at one point in time. “Cross-sectional designs provide a snapshot by collecting data about the independent
and the dependent variables are at the same time” (Schmidt & Brown, 2019, p. 162). The data was expressed as
mean standard deviation. For all measures of daily PA (steps/day and time spent at the various PA intensities)
differences between the three groups were determined using a one-way analysis of variance (ANOVA). Post-hoc
comparisons were done using a Bonferroni test. A level of significance was set at an alpha level of 0.05 with a
power of 0.80 (Buijs et al., 2015, p. 11). Two factors that must be established to conduct a power analysis is
significance level and sample size, which our researchers did. Our text states an ANOVA test design is used when
we are interested in knowing how the groups in a study vary from one another. The ANOVA is an appropriate
design to use when the level of measurement is interval or ratio and there are two or more groups of subjects used
(Schmidt & Brown, 2019, p. 367).
Results
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Ninety-three participants completed the study as three participants from the Maintain group dropped out.
While the Rehab group accumulated more daily PA than the other two groups, they completed more steps per day,
and were less sedentary than the other two groups. Only the Rehab group achieved the recommended daily step
count of more than 6,500 steps per day. The quantity and quality of the PA in the Maintain group was comparable to
that observed in the Acute group. According to the information in Table 2, the findings of the study are significant
(p= < 0.05) using the Acute group as the reference group in the given row. There is a 95% or greater chance that the
findings are due to differences between the variables. The tables show differing levels of PA and how the data
varied from each other. I think the data presented in the tables is clear and easy to understand. Table one covers the
participant’s age, gender, height, weight, BMI, specific cardiac disease, and medications the participants were taking
while in the study. Table two represents the resulting PA from each of the groups. It demonstrates how many how
hours per day each group spent doing either sedentary, light or moderate to vigorous PA. It shows that the Rehab
group completed more planned continuous moderate to vigorous PA. Moreover, both the Rehab and the Maintain
group completed more spontaneous moderate to vigorous PA than what was observed in the Acute group. The
results were measured in the form of mean standard deviation.
Implications
This study provides information on trends of PA and sedentary behaviors in coronary artery disease
patients. This information is helpful for nurses to get an idea of the nonadherence that occurs in some groups of
coronary artery disease and be able to come up with ideas to counteract against those sedentary tendencies.This
research encourages nurses to counsel patients on reducing their sedentary behavior prior to implementing a
structured, prescriptive exercise program. It was observed here that elevated sedentary time was an issue regardless
of whether the participant was entering, finishing or were long retired from a formal cardiac rehabilitation program.
It is implied from this study there is a need for cardiac rehabilitation nurse educators to monitor routine daily PA and
encourage coronary artery disease patients to adjust to a lifestyle that is focused on reducing sedentary behavior by
integrating planned exercise training and unstructured PA throughout the day (Buijs et al., 2015, p. 10). I think that
this study has applicability in my own practice. Coronary artery disease patients should understand that the
importance of PA before, during and after cardiac procedures. It is important that nurses really encourage their
patients and educate them on the health benefits of exercise. It would also behoove us to get creative in getting
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patients motivated to reduce sedentary behaviors. As a nurse, I would really stress the idea that PA should be a
lifelong commitment for everyone, but especially for patients who are susceptible to cardiac diseases.
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Research Article Critique
Buijs, D., Ramadi, A., Macdonald, K., Lightfoot, R., Senaratne, M., & Haennel, R. (2015). Quantity and quality of
daily physical activity in older cardiac patients. Canadian Journal of Cardiovascular Nursing, 25(3), 10-6.
Retrieved from http://www.cinahl.com
Schmidt, N. A., & Brown, J. M. (2019). Evidence-based practice for nurses: Appraisal and application of research
(4th ed). Burlington, MA: Jones & Bartlett Learning.