American Heart Association Lifestyle Recommendations to Reduce Obesity Jane Doe University Project and Practicum Summer 2022 Abstract The prevalence of obesity and sedentary lifestyle complications are increasing at alarming rates, representing a common but preventable cause of severe medical complications like diabetes, cardiovascular diseases, and early mortality. This chronic condition has been for a long time a public health concern and social determinant. The Fitbit app offers a unique opportunity to enhance the efficacy of weight loss plans as it is used to track activity, monitor steps, heart rate, energy expenditure, sleep, and sedentary behavior. The integrative review focused on how the American Heart Association (AHA) Diet and Lifestyle recommendations and the Fitbit app are used as innovative solutions to reduce obesity in adult patients. Research Methodology: A systematic review was conducted to identify research articles completed in the preceding 4-5 years centered on obesity care, diet, physical activity, activity trackers, and lifestyle implications. Results and Discussion: The databases searched were Chamberlain Library, PubMed, and CINHAL. Initial searches yielded over 2000 articles, of which 45 were chosen and examined because they fit the integrative review's theme. The 15 papers most relevant to the PICOT question were studied in further detail and appraised using the Johns Hopkins Evidence Appraisal table. The studies reported positive physical activity outcomes. Conclusions and Further Recommendations:This systematic review supported the effectiveness of the AHA Diet and Lifestyle recommendations to reduce obesity, and clinical use generalization is recommended. Fitbit app provides new ways to improve physical activity habits, and the easy availability of electronic devices may enhance their generalizability use. Keywords: Obesity care; Obesity complications; Lifestyle recommendations; Obesity management; Physical activity intervention using Fitbit activity trackers. Dedication Thanks to my family for their unwavering support of this project; their cooperation means a lot to me. To my husband Armando, thank you for your love, understanding, and patience during this time. I credit my achievement to all of you for your unwavering love and belief in me. Acknowledgments First, I must acknowledge the help of all my professors who inspired, encouraged, and supported me throughout the DNP program. My heartfelt thanks to my teammates, without whom I would never have completed this phase in my life. Their encouragement has had a significant influence on my strong determination during this trip. Contents American Heart Association Lifestyle Recommendations to Reduce Obesity 1 Abstract 2 Introduction Error! Bookmark not defined. Dedication 3 Acknowledgments 4 American Heart Association Lifestyle Recommendations to Reduce Obesity 6 Problem Statement 6 S.

1. American Heart Association Lifestyle Recommendations to
Reduce Obesity
Jane Doe
University
Project and Practicum
Summer 2022
Abstract
The prevalence of obesity and sedentary lifestyle complications
are increasing at alarming rates, representing a common but
preventable cause of severe medical complications like
diabetes, cardiovascular diseases, and early mortality. This
chronic condition has been for a long time a public health
concern and social determinant. The Fitbit app offers a unique
opportunity to enhance the efficacy of weight loss plans as it is
used to track activity, monitor steps, heart rate, energy
expenditure, sleep, and sedentary behavior. The integrative
review focused on how the American Heart Association (AHA)
Diet and Lifestyle recommendations and the Fitbit app are used
as innovative solutions to reduce obesity in adult patients.
Research Methodology: A systematic review was conducted to
identify research articles completed in the preceding 4-5 years
centered on obesity care, diet, physical activity, activity
trackers, and lifestyle implications.
Results and Discussion: The databases searched were
Chamberlain Library, PubMed, and CINHAL. Initial searches
yielded over 2000 articles, of which 45 were chosen and
examined because they fit the integrative review's theme. The
15 papers most relevant to the PICOT question were studied in
further detail and appraised using the Johns Hopkins Evidence

2. Appraisal table. The studies reported positive physical activity
outcomes.
Conclusions and Further Recommendations:This systematic
review supported the effectiveness of the AHA Diet and
Lifestyle recommendations to reduce obesity, and clinical use
generalization is recommended. Fitbit app provides new ways to
improve physical activity habits, and the easy availability of
electronic devices may enhance their generalizability use.
Keywords: Obesity care; Obesity complications; Lifestyle
recommendations; Obesity management; Physical activity
intervention using Fitbit activity trackers.
Dedication
Thanks to my family for their unwavering support of this
project; their cooperation means a lot to me. To my husband
Armando, thank you for your love, understanding, and patience
during this time. I credit my achievement to all of you for your
unwavering love and belief in me.
Acknowledgments
First, I must acknowledge the help of all my professors who
inspired, encouraged, and supported me throughout the DNP
program. My heartfelt thanks to my teammates, without whom I
would never have completed this phase in my life. Their
encouragement has had a significant influence on my strong
determination during this trip.
Contents
American Heart Association Lifestyle Recommendations to
Reduce Obesity 1
Abstract 2
Introduction Error! Bookmark not defined.
Dedication 3
Acknowledgments 4

3. American Heart Association Lifestyle Recommendations to
Reduce Obesity 6
Problem Statement 6
Significance of the Practice Problem 7
Theory or Translational Science Framework 8
Methodology 10
Review Protocol 10
Inclusion/Exclusion Criteria 10
Data Analysis 10
Results and Discussion 11
Characterization of the Body of Literature 11
Findings Synthesis 11
Conclusions and Further Recommendations 12
Implications for Nursing Practice 12
Conclusions and Contributions to the Professions of Nursing 12
Recommendations 12
References 13
Appendix A 18
1
5
American Heart Association Lifestyle Recommendations to
Reduce Obesity
Problem Statement
The Practice Problem Statement
section is 1 paragraph in length. Your introduction
section should smoothly transition into your problem statement.
It should flow logically from the information you provided.
Include your inquiry question, which will provide direction for
your work. Explain your approach to the problem and how your
intervention would be addressed.
Obesity represents a common but preventable cause of
morbidity and severe medical complications. Despite efforts to

4. curb the issue, globally, the annual cases of obesity continue to
rise. Obesity has reached epidemic proportions worldwide,
affecting people's health (Carbone et al., 2022). Physical
activity is advised to minimize the risk of chronic diseases such
as diabetes, cardiovascular disease, and cancer. According to
the literature, it is common to find patients with a sedentary
lifestyle and physical inactivity. Still, wearables and
smartphone apps provide new ways to improve physical activity
habits (Gal et al., 2018). The easy availability of sophisticated
activity trackers such as Fitbit offers a unique opportunity to
enhance the efficacy of computer-tailored interventions. These
advanced activity trackers can monitor steps, heart rate, energy
expenditure, sleep, sedentary behavior, and physical activity
intensity (Vandelanotte et al., 2018). The inquiry question
which provided direction for the integrative review is: In
overweight adult patients in a primary care clinic, what is the
impact of implementing the American Heart Association Diet
and Lifestyle recommendations, compared to standard care, on
body weight in 8-10 weeks?Significance of the Practice Problem
The Significance of the Practice Problem
section is 1-2 pages in length. Start this section with
identification of the practice problem. This section articulates
the issue and its significance from both a global/nationwide
perspective, as well as within the practicum site.
From a global/nationwide perspective, how does the issue
impact nurses, nursing care, healthcare organizations, the
quality of care being provided, society (costs, healthcare policy,
etc.), the patient/client (e.g., pain, suffering, quality of life,
impact on income potential, etc.), the family, healthcare system
(e.g., impact on cost or delivery systems). Discuss the incidence
and/or prevalence and include the financial impact, if at all
possible. You might discuss the impact on length of stay,
readmission, home health care requirements, disability and/or
mortality. Also, you should address any quality, safety, legal,

5. and ethical implications. This discussion must be substantiated
by citations from professional literature. This also applies in
regard to the impact of the issue within the practicum site.
Obesity has become a global epidemic, with at least 2.8 million
people dying yearly from being overweight or obese (WHO,
2021). Obesity has several negative consequences for
population health and healthcare costs (Carbone et al., 2022).
Sedentary behavior and physical inactivity are two of the most
common modifiable risk factors in obese patients. Obesity is a
chronic condition linked to higher mortality and morbidity rates
(WHO,2021). According to the Centers for Disease Control and
Prevention, it causes an estimated 300,000 fatalities yearly in
the United States (CDC, 2021). Obesity co-morbidities include
heart disease, stroke, type 2 diabetes, and some kinds of cancer,
contributing to a lower quality of life and shorter life
expectancy. Obesity affects 93.3 million persons in the United
States and is one of the primary causes of avoidable and early
mortality (CDC, 2021). Internal clinical reports have shown a
significant increase in obese patients at the primary care clinic
practicum site. Physical activity and exercise training help
improve and avoid many chronic diseases, including
cardiovascular disease, in people of all ages, races, ethnicities,
and sexes (Lavie et al., 2019).
At the national level, the rate of obesity-related diseases
represents a severe public health concern that negatively
impacts the community’s quality of life and nursing care
expenses. According to the CDC 2021, obesity is a common,
powerful, and costly disease, and the prevalence and incidence
remain high in the United States. The Centers for Disease
Control and Prevention (CDC) reports that 42.4% of all adults
in the United States are fat, and 650 million individuals
worldwide are obese. Obesity cost USA $190.2 billion in 2018,
accounting for 21% of total healthcare expenses. The
government continues investing a lot of money in healthcare
institutions to provide the most excellent care to patients, and
the economic implications are enormous. Based on the high

6. number of obese patients found at the clinical site, is needed an
innovative intervention to reduce obesity and enhance clinical
outcomes.Theory or Translational Science Framework
The Knowledge to Action Framework served as a framework for
the integrative review. It was developed by Dr. Ian Graham and
his colleagues in 2006 and was founded on over thirty theories
of change. It gives a seven-phase cycle that allows stakeholders
to translate knowledge into practice to enhance outcomes
(Graham & Tetroe, 2010). The model comprises two essential
parts: knowledge generation and action. This model's primary
purpose is to turn evidence into action while monitoring,
evaluating, and tweaking the implementation process (Boscart et
al., 2020). The seven phases in the Knowledge to Action
Framework will serve as a structure and guide for this
integrative review.
The first phase of the Knowledge to Action (KTA) model is to
identify
the problem. The problem should be determined to
inform the most appropriate tool. The practice problem, in this
case, is an increasing prevalence of obesity which needs urgent
intervention. The AHA lifestyle guidelines are a relevant tool
used to prevent and reduce the prevalence of obesity.
The second phase is to adapt knowledge to the local context.
There is a need to identify available stakeholders in the local
context, including available healthcare providers, nurse
managers, and patients. The stage also involves building a
robust infrastructure in the local context and linking the local
context to other model locations.
The third phase is to assess facilitators and barriers to
knowledge use.
This stage involves identifying facilitators to change
and the obstacles that may drag the process or reduce the
outcomes (Kitson et al., 2018). The location is essential as it

7. helps stakeholders utilize the facilitators and address the
barriers. The facilitators include a cooperative patient care
team, and the potential wall is participants may forget to input
data in the tracking app, and others lack proper mobile access.
The challenges can be addressed by educating patients and
sending weekly reminders.
The fourth stage is to select, tailor, and knowledge use
. The step involves mapping and applying the AHA diet
and lifestyle recommendations and use the tracking app to
ensure compliance in the best way possible.
The fifth phase is to monitor knowledge use. Collecting data on
knowledge use is essential and providing the service aligns with
the project purpose (Bryant et al., 2019). It will help
stakeholders make some changes if needed to facilitate the
project.
The sixth phase is to evaluate the outcomes.
It is vital to assess the effects of the strategy
intervention to inform future decisions. Intervention evaluation
helps determine if any goals should be addressed to enhance the
project outcomes (Zhao et al., 2021). The DNP student may
evaluate the results by interviewing patients and the patient’s
care team. Internal sources may also include weight changes, as
evident in the clinic’s data.
Phase seven of the KTA model is to sustain knowledge. There
should be strategies for supporting evidence-based knowledge
to enhance and impact the current practice. Knowledge
implementation is more effective if it is maintained for a long
time. To sustain long-term weight control, nutrition knowledge,
attitudes, and dietary self-regulation are significant predictors
of overweight and obesity (Balani et al., 2019).
Methodology
Review Protocol

8. The Review Protocol
section is 1-2 pages in length. This section is written so
that others can replicate the integrative review. There is a
description in detail of how the integrative review was
conducted, including a description of the search strategy, the
selection of databases used, with justification and the search
terms.
Inclusion/Exclusion Criteria
The Inclusion/Exclusion Criteria
section is 1-2 pages in length. The specific selection
approach is discussed, with an explanation of the selection of
sources included in the review.
Data Analysis
The Data Analysis
section is 1-2 pages in length. Explains how data were
extracted from the sources you selected for the integrative
review, and describes how results from the studies were handled
and combined. Explains the process for how the sources were
analyzed, whether quantitatively or qualitatively, with a
justification of the analytic methods you used and their
appropriateness.
Results and Discussion
Characterization of the Body of Literature
The Characterization of the Body of Literature
section is 2-4 pages in length. The characteristics of the
body of literature provides a thorough review of the quality of
the sources selected for the integrative review, the number of
sources eliminated, the number of sources included, the various
types of journals reviewed, and the methods you used for the
review. The strengths and weaknesses of the sources are
examined.
Findings Synthesis

9. The Findings Synthesis
section is 5-8 pages in length. The findings synthesis
offers a substantial thematic analysis or meta-analysis of the
findings (in a met-analysis, numerical data is combined from
multiple studies to draw new conclusions). The review of the
literature covers all facets of the problem, intervention and
outcomes with numerous (at least 15 primary research articles
and/or systematic reviews no more than 5 years old) references
linking the practice problem and the selected intervention.
Direct quotations are not included, as synthesis of literature is
expected.
The 15 (minimum) primary research studies and/or systematic
reviews are included in Appendix A – The Johns Hopkins
Nursing Evidence-Based Practice Individual Evidence Summary
Tool. Only research evidence is included in the synthesis and on
the evidence table. No secondary sources are included.
Conclusions and Further Recommendations
Implications for Nursing Practice
The Implications for Nursing Practice
section is 1-2 pages in length. The implications of the
project on nursing and healthcare is effectively described, based
on the integrative review. The impact on the appropriate system
(i.e., micro, meso, macro) and recommendations are included.
Some ideas:
· Incorporating regular physical activity, a healthy diet, and a
lifestyle are crucial in preventing and reducing obesity. (micro=
patient level, meso= nursing care, macro= organization level)
· Physical activity and exercise training help improve patient
outcomes and avoid several chronic diseases in people of all
ages, races, ethnicities, and sexes (Lavie et al., 2019).
· Implementing the American Heart Association (AHA) Diet
Lifestyle Recommendations reduces organizations’ costs
associated with obesity care and multiple medical complications

10. related to obesity.Conclusions and Contributions to the
Professions of Nursing
The Conclusions and Contributions to the Professions of
Nursing
section is 1-2 pages in length.
The conclusion reviews the main topics presented and clearly
and effectively summarizes significant conclusions from the
integrative review. Conclusions should relate directly to your
purpose and project question. They are generalizations that loop
back to the existing literature on your topic. For each
conclusion you make, cite the sources that support or contradict
your findings. Conclusions indicate what is now known
regarding nursing practice when your results and results from
prior literature are considered together.Recommendations
The Recommendations section is 1-2 pages in length.
Recommendations based on the findings should be for the
nursing profession and society in general, and to specific
nursing leaders as mentioned in the significance portion. A
summary of the major findings concludes the findings and
interpretations portion with a transitional paragraph introducing
the recommendations portion. Be sure to make specific
recommendations for leaders in the nursing field and policy
makers. Recommendations for future research should be
detailed and extensive.
References
The References page begins on a new page and there must be a
corresponding reference for every intext citation used within the
paper. References are current (published within last five years
or seminal studies), from peer-reviewed journals, minimal
secondary sources, and all are appropriate to the identified

11. nursing problem and intervention. Also include the 15 articles
that supports the integrative review and are containing in the
appendix A. ***(The 15 articles that are supposed to be used
for the integrative review are highlighted, and some other used
before or possible article for use are in the following references
list for your consideration. Feel free to use the ones you find
pertinent.
Appendix A is in the right place, it is completed, and
reviewed, please keep it as is).***
American Heart Association. (2021, November 21). The
American Heart Association diet and lifestyle recommendations.
www.heart.org.
https://www.heart.org/en/healthy-living/healthy-
eating/eat-smart/nutrition-basics/aha-diet-and-lifestyle-
recommendations
Balani, R., Herrington, H., Bryant, E., Lucas, C., & Kim, S. C.
(2019). Nutrition knowledge, attitudes, and self-regulation as
predictors of overweight and obesity.
Journal of the American Association of Nurse
Practitioners, 31(9), 505–510.
https://doi.org/10.1097/JXX.0000000000000169
Beauchamp, M. R., Ruissen, G. R., Dunlop, W. L., Estabrooks,
P. A., Harden, S. M., Wolf, S. A., Liu, Y., Schmader, T.,
Puterman, E., Sheel, A. W., & Rhodes, R. E. (2018). Group-
based physical activity for older adults (GOAL) randomized
controlled trial: Exercise adherence outcomes. Health
psychology: official journal of the Division of Health
Psychology, American Psychological Association, 37(5), 451–
461.
https://doi.org/10.1037/hea0000615
Bergum, H., Sandven, I., & Klemsdal, T. (2021). Long-term
effects (>24 months) of multiple lifestyle interventions on
major cardiovascular risk factors among high-risk subjects: A
meta-analysis.

12. BMC Cardiovascular Disorders, 21(1).
https://doi.org/10.1186/s12872-021-01989-5
Boscart, V., Davey, M., Crutchlow, L., Heyer, M., Johnson, K.,
Taucar, L. S., ... & Heckman, G. (2020). Effective chronic
disease interventions in nursing homes: a scoping review based
on the knowledge-to-action framework.
Clinical gerontologist, 1-14.
https://doi.org/10.1080/07317115.2019.1707339
Bray, G. A., & Ryan, D. H. (2021). Evidence-based weight-loss
interventions: Individualized treatment options to maximize
patient outcomes. Diabetes, obesity & metabolism, 23 Suppl 1,
50–62.
https://doi.org/10.1111/dom.14200
Brickwood, K. J., Watson, G., O'Brien, J., & Williams, A. D.
(2019). Consumer-based wearable activity trackers increase
physical activity participation: Systematic review and meta-
analysis.
JMIR mHealth and uHealth, 7(4), e11819.
https://doi.org/10.2196/11819
Carbone, S., Lavie, C. J., Elagizi, A., Arena, R., & Ventura, H.
O. (2020). The Impact of Obesity in Heart Failure. Heart failure
clinics, 16(1), 71–80.
https://doi.org/10.1016/j.hfc.2019.08.008
Centers for Disease Control and Prevention. (2021, February
11). Adult obesity facts.
Følling, I. S., Oldervoll, L. M., Hilmarsen, C., & Ersfjord, E.
(2021). A qualitative study explores the use of activity monitors
for patients with obesity during weight-loss treatment.
BMC sports science, medicine & rehabilitation, 13(1),
25.
https://doi.org/10.1186/s13102-021-00253-9
Gal, R., May, A., van Overmeeren, E., Simons, M., &
Monninkhof, E. (2018). The effect of physical activity
interventions comprising wearables and smartphone applications
on physical activity: A systematic review and meta-analysis.
Sports Med Open, 4(1).

13. https://doi.org/10.1186%2Fs40798-018-0157-9
Graham, I. D., & Tetroe, J. M. (2010). The knowledge to action
framework.
Models and frameworks for implementing evidence-
based practice: Linking evidence to action,
207, 222.
https://doi.org/10.1002/chp.47
Groessl, E. J., Kaplan, R. M., Rejeski, W. J., Katula, J. A.,
Glynn, N. W., King, A. C., Anton, S. D., Walkup, M., Lu, C. J.,
Reid, K., Spring, B., & Pahor, M. (2019). Physical Activity and
Performance Impact Long-term Quality of Life in Older Adults
at Risk for Major Mobility Disability.
American journal of preventive medicine,
56(1), 141–146.
https://doi.org/10.1016/j.amepre.2018.09.006
Hu, L., Illiano, P., Pompeii, M. L., Popp, C. J., Kharmats, A.
Y., Curran, M., Perdomo, K., Chen, S., Bergman, M., Segal, E.,
& Sevick, M. A. (2021). Challenges of conducting a remote
behavioral weight loss study: Lessons learned and a practical
guide.
Contemporary Clinical Trials, 108, 106522.
https://doi.org/10.1016/j.cct.2021.106522
Jenum, A. K., Brekke, I., Mdala, I., Muilwijk, M.,
Ramachandran, A., Kjøllesdal, M., Andersen, E., Richardsen, K.
R., Douglas, A., Cezard, G., Sheikh, A., Celis-Morales, C. A.,
Gill, J., Sattar, N., Bhopal, R. S., Beune, E., Stronks, K.,
Vandvik, P. O., & van Valkengoed, I. (2019). Effects of dietary
and physical activity interventions on the risk of type 2 diabetes
in South Asians: meta-analysis of individual participant data
from randomised controlled trials.
Diabetologia,
62(8), 1337–1348.
https://doi.org/10.1007/s00125-019-4905-2
Jiang, Q., Li, J. T., Sun, P., Wang, L. L., Sun, L. Z., & Pang, S.
G. (2022). Effects of lifestyle interventions on glucose
regulation and diabetes risk in adults with impaired glucose

14. tolerance or prediabetes: a meta-analysis. Archives of
endocrinology and metabolism, 66(2), 157–167.
https://doi.org/10.20945/2359-3997000000441
Kitson, A., Brook, A., Harvey, G., Jordan, Z., Marshall, R.,
O’Shea, R., & Wilson, D. (2018). Using complexity and
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Blair, S. N. (2019). Sedentary Behavior, Exercise, and
Cardiovascular Health. Circulation Research, 124(5), 799–815.
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McIlvenna, Y., Stefanetti, R., Trenell, M., ... Taylor, R. (2018).
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Johannsen, N. (2018). The Effects of Exercise and Physical
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11
Appendix A
Johns Hopkins Nursing Evidence-Based Practice
Individual Evidence Summary Tool
© The Johns Hopkins Hospital/Johns Hopkins University. May
not be used or reprinted without permission.
Practice Question: In overweight adult patients in a primary
care clinic, what is the impact of implementing the American
Heart Association Diet and Lifestyle recommendations,
compared to standard care, on body weight in 8-10 weeks?
Date: 11/10/2022
Article Number
Author and Date
Evidence Type

16. Sample, Sample Size, Setting
Findings That Help Answer the EBP Question
Observable Measures
Limitations
Evidence Level, Quality
1
Balani, 2019.
https://doi.org/10.1097/JXX.0000000000000169
Experimental study.
A total of 313 adults participated in an online survey.
-Poor eating self-regulation enhances weight gain.
-Nutrition knowledge and attitudes matter.
Examine knowledge and attitudes.
Possibility of subjective bias.
Level II, Good.
2
Beauchamp, 2018.
https://doi.org/10.1037/hea0000615
Randomized controlled trial (RCT).
Enrolled 627 older adults, conducted in Greater Vancouver,
Canada, using two group-based exercise programs for older
adults.
-Provide support for the efficacy of group-based physical
activity programs.
-Promotes exercise adherence behavior.
Efficacy of group-based physical activity programs.
Validity depends on multiple sites.
Level I, High.
3
Bergum, 2021
https://doi.org/10.1186/s12872-021-01989-5

17. Systematic Review and Meta-Analysis of randomized controlled
trial (RCT).
Six thousand three hundred fifty patients from three
geographical regions; North America (6 trials), Western Europe
(5 shots), and Oceania (1 trial).
-Lifestyle recommendations reduce blood pressure.
-Lifestyle interventions do not have a significant impact on
cholesterol.
Efficacy of lifestyle intervention.
Subjectivity bias.
Heterogeneity.
Level I, Good.
4
Brickwood, 2019.
https://doi.org/10.2196/11819
Systematic Review and Meta-Analysis.
A random-effects meta-analysis was completed on 7 studies
that reported changes in sedentary behavior.
-Consumer-based wearable trackers enhance monitoring and
support, and also increase participation in physical activities.
Effects of consumer-based wearable activity trackers.
Risk of bias.
Level I, Good.
5
Folling, 2021.
https://doi.org/10.1186/s13102-021-00253-9
Observational study.
Twenty-nine informants (aged 21 to 66 years) were interviewed;
59% were female.
-Activity monitors can enhance or undermine weight-loss
programs.
-Individualized monitors work better.
Patients’ experiences.
Does not demonstrate causality.

18. Prone to bias.
Level III, Good.
6
Gal, 2018.
https://doi.org/10.1186%2Fs40798-018-
0157-9
Systematic Review and Meta-Analysis of randomized controlled
trial (RCT).
18 studies were included in this review. The included studies
involved 2734 participants from different populations.
-Wearables and smartphone applications promote physical
activity among adults.
Effects of physical activity.
Risk of bias.
Level II, Good.
7
Groessl, 2019.
https://doi.org/10.1016/j.amepre.2018.09.006
Randomized controlled trial (RCT).
Multisite RCT compared physical activity to health education
among 1,635 randomly assigned sedentary older adults at risk
for mobility disability.
- Physical activity interventions can slow the decline in quality
of life.
Activity interventions
Risk of bias.
Level I, High.
8
Hu, 2021.
https://doi.org/10.1016/j.cct.2021.106522
Randomized controlled trial (RCT).
Among 135 participants included in the analysis, the median
attendance rate for the 14 remote sessions was 85.7%.
-Connectivity is a great challenge in remote monitoring.
-Self-monitoring apps are easy to use.

19. Describe challenges and lessons.
Low external validity.
Level I, High.
9
Jenum, 2019.
https://doi.org/10.1007/s00125-019-4905-2
Meta-analysis of RCTs.
Individual participant data on 1816 participants from all six
eligible RCT trials (four from Europe and two from India).
- lifestyle modification interventions in high-risk South Asian
populations resulted in a clinically important 35% relative
reduction in diabetes incidence.
lifestyle modification interventions.
Limited generalizability.
Level I, High.
10
Jiang, 2022.
https://doi.org/10.20945/2359-
3997000000441
Meta-analysis of RTCs.
Thirteen RCTs involving 3376 individuals with IGT, or
prediabetes were selected for this meta-analysis.
- Risk of diabetes was significantly reduced in individuals who
received lifestyle interventions and were associated with lower
FPG.
Investigate the role of lifestyle interventions on glucose
regulation and delay the onset of diabetes in adults.
Limited generalizability.
Level I, High.
11
Lean, 2018.
https://doi.org/10.1016/S0140-
6736(17)33102-1
Randomized controlled trial (RCT).
3006 individuals from 9 primary care practices in Scotland and

20. the Tyneside region of England were randomly assigned (1:1)
via a computer-generated list.
-Intensive weight management programs helped to achieve
remission of type 2 diabetes.
Assess the impact of intensive weight management.
Limited generalizability.
Level I, High.
12
Ma, 2017.
https://doi.org/10.1136/bmj.j4849
Systematic review and meta-analysis of randomised controlled
trials (RCTs).
54 RCTs with 30 206 participants were identified.
- high quality evidence showed that weight loss interventions
decrease all-cause mortality.
Assess the impact of weight loss interventions.
Risk of bias.
Level I, High.
13
Swift, 2018
https://doi.org/10.1016/j.pcad.2018.07.014
Systematic Review of RTCs.
Evaluated weight loss from exercise training programs (ET)
composed of aerobic training, resistance training, and programs
that combine diet and ET.
-Minimum requirements for exercise are not clinically
significant for weight loss.
-Combination of exercise and diet leads to better outcomes.
Effects of exercise and physical activity.
Susceptible to biasness.
Level III, Good.
14
Wadden, 2020.
https://doi.org/10.1037/amp0000517
Systematic Review of RTCs.
Evaluate 10 articles that reflect the contributions of multiple

21. psychologists to the development and treatment of obesity in
children, adolescents, and adults.
Face-to-face counseling sessions are practical.
High levels of physical activity and reduced calorie
consumption.
Effects of intensive behavioral interventions.
Lacks generalizability.
Level III, Good
15
Vandelanotte, 2018.
https://www.jmir.org/2018/12/e11321?rel=0
Randomized controlled Trial (RTC).
A total of 243 Australian adults participated.
Fitbit activity trackers increase total weekly activities.
Effectiveness of web-based computer-tailored intervention.
Validity depends on multiple sites.
Level I, High.
image1.emf
image2.emf
Title of Paper
First Name Last Name
University
Project and Practicum
Session Year

22. NOTE: This is a template and guide.
Delete all directions as you build your paper.
Abstract
The abstract is 150-200 words in length (
no more than 1 page). The abstract is structured by the
following subheadings:
Introduction:
Research Methodology:
Results and Discussion:
Conclusions and Further Recommendations:
Keywords: (List 5 to 6 keywords in regular font here)
Dedication
[Directions – a dedication provides the author with the
opportunity to thank people who may have special meaning in
the author’s life. For example – you may want to thank your
spouse or a specific family member for their support during
your doctoral education. The deduction does not need to be long
but it should convey your appreciation for the contribution this
or these individuals made in your life while you were a doctor
of nursing practice student. The dedication is written as a part
of your final DNP writing in NR709.]
Acknowledgements
[Directions – the acknowledgement page is reserved for the
author to acknowledge the important role specific professional
people have made towards the successful completion of the
project. In the acknowledgement page, you may want to thank
your professors, your preceptor, your mentor, or others. This is
the perfect place to acknowledge the practicum site and your
colleagues that supported you through the completion of your
doctoral education. Again, the acknowledgement page does not

23. need to be long, but it does need to include professionals that
helped you during your education. This page is completed in
NR709 as a part of your final writing.]
Contents
1
Abstract 2
Dedication 3
Acknowledgements 4
Introduction 6
Problem Statement 6
Significance of the Practice Problem 6
Theory or Translational Science Framework 7
Methodology 8
Review Protocol 8
Inclusion/Exclusion Criteria 8
Data Analysis 8
Results and Discussion 8
Characterization of the Body of Literature 8
Findings Synthesis: 9
Conclusions and Further Recommendations 9
Implications for Nursing Practice 9
Conclusions and Contributions to the Professions of Nursing 9
Recommendations 10
References 11
Appendix A 13
1
5
Title of Paper
The introduction section is 1-2 paragraphs in length. Note there
is
no heading that says Introduction. The paragraph or two
following the title on the first page of your text is assumed to
be your introduction. Your introduction follows the title of your

24. paper (note it is not bolded). You should start your introduction
with a powerful statement or two to stimulate interest. You
should identify the purpose of your paper and provide a preview
of what the paper will include. Remember formal papers are in
third person so do not us
e I, me, we, etc.
Refer to yourself as the DNP student.
Problem Statement
The Practice Problem Statement
section is 1 paragraph in length. Your introduction
section should smoothly transition into your problem statement.
It should flow logically from the information you provided.
Include your inquiry question, which will provide direction for
your work. Explain your approach to the problem and how your
intervention would be addressed.
Significance of the Practice Problem
The Significance of the Practice Problem
section is 1-2 pages in length. Start this section with
identification of the practice problem. This section articulates
the issue and its significance from both a global/nationwide
perspective, as well as within the practicum site.
From a global/nationwide perspective, how does the issue
impact nurses, nursing care, healthcare organizations, the
quality of care being provided, society (costs, healthcare policy,
etc.), the patient/client (e.g., pain, suffering, quality of life,
impact on income potential, etc.), the family, healthcare system
(e.g., impact on cost or delivery systems). Discuss the incidence
and/or prevalence and include the financial impact, if at all
possible. You might discuss the impact on length of stay,
readmission, home health care requirements, disability and/or
mortality. Also, you should address any quality, safety, legal,
and ethical implications. This discussion must be substantiated
by citations from professional literature. This also applies in

25. regard to the impact of the issue within the practicum site.
Theory or Translational Science Framework
The Theory or Translation Science Framework
section is 1-2 pages in length. The theory or translation
science framework is appropriate to the problem and/or
intervention and the student’s identified practice area. There is
clear linkage between the components of the framework and the
elements of the problem and/or intervention.
Methodology
Review Protocol
The Review Protocol
section is 1-2 pages in length. This section is written so
that others can replicate the integrative review. There is a
description in detail of how the integrative review was
conducted, including a description of the search strategy, the
selection of databases used, with justification and the search
terms.
Inclusion/Exclusion Criteria
The Inclusion/Exclusion Criteria
section is 1-2 pages in length. The specific selection
approach is discussed, with an explanation of the selection of
sources included in the review.
Data Analysis
The Data Analysis
section is 1-2 pages in length. Explains how data were
extracted from the sources you selected for the integrative
review, and describes how results from the studies were handled
and combined. Explains the process for how the sources were
analyzed, whether quantitatively or qualitatively, with a
justification of the analytic methods you used and their
appropriateness.
Results and Discussion

26. Characterization of the Body of Literature
The Characterization of the Body of Literature
section is 2-4 pages in length. The characteristics of the
body of literature provides a thorough review of the quality of
the sources selected for the integrative review, the number of
sources eliminated, the number of sources included, the various
types of journals reviewed, and the methods you used for the
review. The strengths and weaknesses of the sources are
examined.
Findings Synthesis
The Findings Synthesis
section is 5-8 pages in length. The findings synthesis
offers a substantial thematic analysis or meta-analysis of the
findings (in a met-analysis, numerical data is combined from
multiple studies to draw new conclusions). The review of the
literature covers all facets of the problem, intervention and
outcomes with numerous (at least 15 primary research articles
and/or systematic reviews no more than 5 years old) references
linking the practice problem and the selected intervention.
Direct quotations are not included, as synthesis of literature is
expected.
The 15 (minimum) primary research studies and/or systematic
reviews are included in Appendix A – The Johns Hopkins
Nursing Evidence-Based Practice Individual Evidence Summary
Tool. Only research evidence is included in the synthesis and on
the evidence table. No secondary sources are included.
Conclusions and Further Recommendations
Implications for Nursing Practice
The Implications for Nursing Practice
section is 1-2 pages in length. The implications of the
project on nursing and healthcare is effectively described, based
on the integrative review. The impact on the appropriate system

27. (i.e., micro, meso, macro) and recommendations are included.
Conclusions and Contributions to the Professions of
Nursing
The Conclusions and Contributions to the Professions of
Nursing
section is 1-2 pages in length.
The conclusion reviews the main topics presented and clearly
and effectively summarizes significant conclusions from the
integrative review. Conclusions should relate directly to your
purpose and project question. They are generalizations that loop
back to the existing literature on your topic. For each
conclusion you make, cite the sources that support or contradict
your findings. Conclusions indicate what is now known
regarding nursing practice when your results and results from
prior literature are considered together.Recommendations
The Recommendations section is 1-2 pages in length.
Recommendations based on the findings should be for the
nursing profession and society in general, and to specific
nursing leaders as mentioned in the significance portion. A
summary of the major findings concludes the findings and
interpretations portion with a transitional paragraph introducing
the recommendations portion. Be sure to make specific
recommendations for leaders in the nursing field and policy
makers. Recommendations for future research should be
detailed and extensive.
References
11
The References page begins on a new page and there must be a
corresponding reference for every intext citation used within the
paper. References are current (published within last five years
or seminal studies), from peer-reviewed journals, minimal

28. secondary sources, and all are appropriate to the identified
nursing problem and intervention. Appendix A
Johns Hopkins Nursing Evidence-Based Practice
Individual Evidence Summary Tool
© The Johns Hopkins Hospital/Johns Hopkins University. May
not be used or reprinted without permission.
Article #
Author & Date
Evidence Type
Sample, Sample Size & Setting
Study findings that help Answer the EBP Question
Observable Measures
Limitations
Evidence Level & Quality