The effect of a school nurse led education intervention on blood pressure and physical activity levels in adolescents

11 CHAPTER I: INTRODUCTION . 12 Purpose and Objectives of the Study . 12 The Significance of Physical Activity: Background and Rationale . 12 Assumptions . 18 Definition of Terms . 18 CHAPTER II: LITERATURE REVIEW . 20 Historical Perspectives of Physical Activity . 20 Conclusion . 51 Theoretical Context of Empowerment . 51 Supplemental Theoretical Context of Peer Leaders . 54 Summary . 56 CHAPTER III: METHODS AND PROCEDURES . 58 Research Design . 58 Sample and Setting . 58 Ethical Considerations . 60 Demographics . 61 Questionnaire . 61 Physical Measures . 62 Instruments and Data Collection Procedure . 62 PA and Blood Pressure 7 Statistical Tests . 64 Data Management and Analysis . 66 Methodological Limitations . 67 Summary . 67 CHAPTER IV: RESULTS . 68 Introduction . 68 Data Analysis . 68 Descriptive Statistics . 68 T Test . 69 Pearson Correlation . 72 Results Summary . 74 CHAPTER V: DISCUSSION AND SUMMARY . 75 Research Questions . 75 Interpretation . 76 Limitations of the Study . 78 Strengths of the Study . 78 Recommendations for Education . 78 Future Research . 79 Summary . 79 References . 81 Appendices . 100 PA and Blood Pressure 8 APPENDIX Appendix A Education Intervention Lesson Plan . 100 Appendix B PACE + Adolescent Tool . 103 Appendix C Physical Measures Data Collection Worksheet . 104 Appendix D Informed Consent Form Parent Version . 105 Appendix E Informed Consent Form Adolescent Version . 108 Appendix F Participant Research Rights . 111 PA and Blood Pressure 9 LIST OF TABLES TABLE PAGE 1. Frequency and Percent of Race in Study Participants . 69 2. Mean Averages of blood pressure (BP) and PACE Variables by Experimental and Control Group . 70 3. Mean Measures of Variables Comparing Pre and Post . 71 4. Bivariate Correlations of Blood Pressure and Physical Activity Measures . 72 PA and Blood Pressure 10 LIST OF FIGURES FIGURE PAGE 1.Gender in Study Participants . 69 2.Scatterplot of Pre A Average Systolic Blood Pressure and Pre A P2 PACE Measure . 72 3. Scatterplot of Pre A Mean Diastolic Blood Pressure and Pre A P2 PACE Measure . 73 4. Scatterplot of Post D Mean Systolic Blood Pressure and Post D P2 PACE Measure . 73 5. Scatterplot of Post D Mean Diastolic Blood Pressure and Post D P2 PACE Measure . 74 PA and Blood Pressure 11 Abstract Regular physical activity (PA) is a necessary health promotion behavior for adolescents. Benefits of regular physical activity are optimal body weight, lowering blood pressure (BP), and decreasing risk factors for chronic illnesses. Yet declining physical activity levels and increasing sedentary behaviors along with the rising prevalence of overweightRegular physical activity (PA) is a necessary health promotion behavior for adolescents. Benefits of regular physical activity are optimal body weight, lowering blood pressure (BP), and decreasing risk factors for chronic illnesses. Yet declining physical activity levels and increasing sedentary behaviors along with the rising prevalence of overweight and obesity, type 2 diabetes, and hypertension exists in teenagers. The purpose of this quantitative research was to study the effects of a School Nurse led teaching intervention to promote physical activity as a healthy behavior on blood pressures and physical activity levels in adolescents. Youth empowerment was the theoretical framework for the study and a peer leader was incorporated. A true experimental design used repeated measures with the same intervention for a total of 4 measures (two before intervention and two after intervention) was implemented. The intervention group received a School Nurse led education session on the healthy benefits of PA. The measures were blood pressure, pulse, body mass index, and physical activity levels. A significant drop in systolic blood pressure was found in the intervention group after education. A negative relationship was found between both systolic blood pressure (SBP) and physical activity levels and diastolic blood pressure (DBP) and physical activity levels. Mean physical activity levels increased in the intervention group post education. Possible implications for School Nurse practice include further study, continued use of School Nurse led education programs with teens and dissemination of the findings to other School Nurses. PA and Blood Pressure 12 The Effect of a School Nurse Led Education Intervention on Blood Pressure and Physical Activity Levels in Adolescents CHAPTER ONE: BACKGROUND, PURPOSE, RESEARCH QUESTIONS AND SIGNIFICANCE Physical activity (PA) helps control weight, reduces blood pressure (BP) (American Academy of Pediatrics, 2000) raises high density lipoprotein (HDL) cholesterol, reduces risks of type 2 diabetes, and improves well-being (American Heart Association, 2007). However, there is a well-documented trend of declining PA levels in United States (US) adolescents and an increase in sedentary lifestyle practices while the prevalence of overweight and obese youth is climbing at an alarming rate. This study addressed an intervention that a school nurse can take to promote physical activity in youth. Purpose and Objectives of Study The purpose of the study was to examine the effect of a school nurse led educational intervention on the healthy benefits of PA by measuring PA levels and blood pressures in adolescents. The study had as its aim the following three objectives. The first objective was to implement an education lesson about blood pressure and the benefits of PA on blood pressure with the treatment group. Second, to measure 2 pre-treatment and 2 posttreatment blood pressure, pulse, body mass index (BMI), and PA measures, and third, to use the findings to suggest possible school nurse practice changes based on evidence. The Significance of PA: Background and Rationale PA has been studied to determine the health promotion benefits. Ishikawa-Takata, Ohta, and Tanaka (2003) found significant reductions in blood pressure in adult groups PA and Blood Pressure 13 that exercised on a regular basis. The study included a sedentary control group and groups that exercised for differing amounts for 8 weeks. Even the group that only exercised to 30 to 60 minutes per week had significant blood pressure reductions. The group that had the most blood pressure reduction was the group that exercised for over 120 minutes per week. Blair, Thompson, and Church (2006) pointed out that over 20,000 articles were published yearly on the topic of exercise and cardiovascular disease. It was stressed that low fitness levels were the highest predictors of heart disease events. Although this is not specific to hypertension, lowering blood pressure was included in th