Analyzing Exercise in Obese Older Adults

Introduction

The critical appraisal is referred to the process of focussed and systematic analysis of scientific outcome of research to evaluate its value, trustworthiness and relevance regarding a certain context (LoBiondo-Wood and Haber, 2017). It is essential as critical appraisal helps to refute unnecessary claims made in the existing research with high-value evidence to determine the extent of its appropriateness and validity (Canning et al.2016). In this study, the critical appraisal of paper named “Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults” is to be made with the help of using CASP framework, which is also a critical aspect of healthcare dissertation help.

Justification for using CASP Framework

The Critical Appraisal Skill Programme (CASP) tool has the key aim to develop skills for findings and understanding of research evidence to assist the researcher in applying gathered evidence with appropriate idea of its effectiveness in practice (O'Donoghue et al. 2019). Thus, it is important to be used in appraising the current study as it is going to critically analyse evidence in the study to determine its actual effectiveness in healthcare practice. As mentioned by Relph et al. (2020), CASP framework allows researchers to identify potential threats and limitation present in a study. This ensures its effectiveness of use in appraising articles as it leads the researchers to evaluate the validity and reliability of the study with appropriateness. In CASP framework, two of the focus includes identifying potential outcomes of any study and the way the results are helpful to be locally implemented in supporting decision-making in any field (Harper et al. 2018). Thus, it is effective to be used in analysis of the current articles as it would help to identify the potential results and evidence that proves compared impact of aerobic or resistance exercise in dieting obese adults creating opportunity for the healthcare workers understand the importance of the implementation of evidence in practice. As asserted by Bostock (2017), CASP framework provides separate checklists for analysis of strength and weakness of information based on each research design. This makes it effective to be used for analysing the current article as specific systematic process can be followed in appropriately evaluating the evidence.

Critical Analysis

Introduction and Methodology

The article by Villareal et al. (2017) is seen to present a well-focused abstract and introduction regarding the topic of their interest. The presence of an appropriate abstract and introduction regarding the research topic in the article provides prospective readers the ability to judge the relevance of the study in relation to their area of research (Reges et al. 2018). Thus, the presence of appropriate abstract and introduction in the topic acts as its strength as allowed readers can be able to execute initial review to determine if the article meets their research requirements. The CASP Framework informs that issues to be focused in the study are to be clearly mentioned in potential piece of research. This is because it allows the researcher to effectively express the aspiration and intention of the study in summarised way for potential readers to have ability to understand the content being explored in the study (CASP, 2018). In the study by Villareal et al. (2017), an appropriate aim highlighting the key issue to be explored in the study which acts as its strength. This is because it helps to highlight the information that is to be explored in the study providing reader be able to save time by avoiding wasting on researching for irrelevant topic that is not related to their field of research.

The CASP framework mentions that detailed information about the way the population is considered for the study is to be present. This is because it helps to determine whether or not appropriate measures are taken to potentially select relevant population who ensure valid and reliable gathering of information in enriched execution of the study (CASP, 2018). In the study of Villareal et al. (2017), it is seen that clear specifications of the population considered for the study is mentioned. This is evident as the study explained that for the clinical trial the researcher selected 160 obese older adults through the help of advertisement and comprehensive medical screening to ensure appropriate samples are included in the study. The presence of explanation of inclusion and explanation criteria in studies is important as it ensures effective protocols are followed in justified selection of subjects who show appropriateness to be included in the study for it enriched and effective execution (Calvert et al. 2018). Thus, the presence of explanation of inclusion and exclusion criteria in the study of Villareal et al. (2017) acts as its strength as it allows its enriched conduction with appropriately selected sample relevant to the study topic.

The CASP framework informs that the intervention given to the population in gathering results for the study are to be well-explained (CASP, 2018). In the study of Villareal et al. (2017), effective explanation of the intervention made for the population to gather evidence for the study is present. This is evident as the study mentioned that they executed the intervention of weight management and exercise intervention for four groups in the study in which the control group is also present. The well-explained intervention made for participants acts as strength for the study as it informs the way outcome of interest is received. The advantage of randomised control trial (RCT) is that it allows to directly compare data regarding the efficacy of a treatment for different patients. Moreover, the RCT acts as strength for any study because it lowers participant selection bias and ensures statistical reliability of the results, in turn, ensuring authenticated presentation of results without error (Gounder et al. 2016). Therefore, RCT use acts as strength for the study by Villareal et al. (2017). The disadvantage of RCT is that it includes long follow-up process in gathering information making it time-consuming study along with require large sample size which may not be available (Cummings and Rubino, 2018). However, none of these limitations is faced in the study due to RCT as adequate time and participants are present to be used leading it avoided to be acted as weakness in execution of research.

According to the CASP framework checklist, in randomised control trial studies, they ask whether or the recruitment of participants for intervention is randomized (CASP, 2018). In the given study, it is seen that the recruitment of participants in control and experimental groups are randomly done. It is evident as the study mentioned participants that were the obese older adults are randomly assigned to weight-management program along with one of the three exercise programs that are resistance training, aerobic exercise or combined aerobic and resistance training or to the control group (Villareal et al., 2017). This act as strength for the study because randomised recruitment of sample in groups creates equal chances for all the selected individuals to be chosen for participation in the study and limit selection bias that may raise error in the study (Trepanowski et al. 2017). The CASP framework mentions determining whether or not all the participants who entered the trial completed the study and accounted for the conclusion (CASP, 2018). In the given study, not all the participants who entered the trial accounted for the conclusion as out of 160 selected participants only 141 provided their response and completed the study. The participant attrition may have created weakness for the study because it reduces the overall sample size, in turn, jeopardizing the statistical power of results (Villareal et al., 2017).

In the study by Villareal et al. (2017), the participants are seen to be well-informed regarding the reason for their participation and the way their responses are to be used. This acted as strength for the study as it is allowed it to be executed with informed consent from the participants who understand the value of their responses, in turn, avoiding to manipulate information (Srivastava et al. 2019). The CASP tool mentions to ask whether the groups remained similar at the initiation of the trial till the end (CASP, 2018). The steady management of group during the execution of the study helps to avoid creation of error in gathering information. In the study by Villareal et al. (2017), the groups remained in similar manner at the initial and end of the trial which acts as the strength for the study to provide steady results and outcome in the research. The CASP framework for RCT studies asks to mention whether or not all the groups were equally treated apart from experimental intervention (CASP, 2018). In the given study, it is seen that all the groups are equally treated aside from experimental intervention and no additional support are used for management of the groups.

Results

The CASP framework mentions to determine the outcomes of the study along with the extent to which it was effective. This is to be made by considering the outcomes developed and result found for each outcome (CASP, 2018). The presentation of detailed findings is important for the research as it helps to reach confirmation or rejection of hypothesis followed in executing the study. However, detailed outcome is also important to help articulation of the results in understanding the problem raised in in-depth manner from various perspectives (Vetter and Mascha, 2017). In the study by Villareal et al. (2017), detailed information on the outcome and extent of the impact of intervention was mentioned. This is evident as the study mentioned detailed scores regarding Physical Performance Test (PPT) which is considered as primary outcome from baseline to six-month follow-up and information in regard to the secondary outcomes such as body composition, frailty measures, physical function and bone mineral density. The PPT scores as primary outcome for experimental groups and the control group mentioned that there was 21% increased from baseline in combination group of aerobic or resistance exercise whereas it increased by 14% in the other groups with only 4% in the control group (Villareal et al., 2017). This result is useful to indicate that dieting obese adults with aerobic and resistance exercise would show increased efficiency to tackle physical movement compared to people who are involved in either of the exercise regimes.

The results further revealed that people in the combined group where resistance and aerobic exercise were both provided for dieting obese adults experienced 14% higher score than the baseline for functional status compared to the resistance group that scored 8% and aerobic group that scored 7% more from baseline for functional status (Villareal et al., 2017). The functional status in healthcare referred to the ability of an individual to accomplish daily activities in normal way to meet basic needs such as maintaining health and well-being, fulfilling usual roles and others (Veasey et al. 2018). Thus, the result developed is useful as it indicates that combined aerobic and resistance exercise are more effective than using either one among dieting obese adults to increase their efficiency in managing everyday work activities and meeting basic needs by overcoming weight issues. The strength of mentioning of primary outcome in the study is that it reduces risk of developing false-negative error that may occur from the statistical testing of other outcomes along with lower chances of false-positive error by creating basis to estimate sample size required for potential study (Ferreira and Patino, 2017). Thus, the demarcation of primary outcome in the study acted as its strength for its enhanced representation of results.

The secondary outcomes are referred to additional outcomes which are considered to assist in interpretation of the results gathered in the primary outcome (Ferreira and Patino, 2017). In this study, to support the primary outcomes, the secondary outcomes are also mentioned in detail. This acts as strength for the study as it helped to inform the reason behind the primary outcomes (Ferreira and Patino, 2017). The secondary outcome regarding body composition informed that there was 9% reduction from baseline scores in body weight among individuals in the aerobic group, resistance group and combined group. However, no significant change in body weight composition was observed in the control group (Villareal et al. 2017). In regard to fat-mass scores, the combination and aerobic groups expressed 17% decline from the baseline whereas 16% decline from baseline score is seen among the resistance group (Villareal et al. 2017). The fat-mass reduction indicates loss of extra fat from the body resulting to reduce body weight (Han et al. 2018). In obese individuals, mainly the build-up of extra fat in the body is result to raise their BMI rate and create additional health risk such as cardiovascular disease, diabetes and others along with hindrance in making movement and executing everyday function effectively (Francisco et al. 2018). Thus, the results developed is useful as reduction in fat-mass among the combination and aerobic group explained that out of low fat, enhanced mobility and functional capability of the dieting obese adults were presented in combination groups due to which they presented higher PPT score compared to resistance and control groups.

In the study by Villareal et al. (2017), the secondary outcome in regard to bone mineral density mentioned that total hip density decreased less than 1% in resistance group from baseline data but it reduced by 2.6% in aerobic group and 1.1% in combination group. The secondary outcomes also mentioned that time required to resolve an obstacle course was decreased by 13% in combination group whereas it decreased only by 7% aerobic group (Villareal et al. 2017). The results are useful to explain that combination group showed increased efficacy compared to other groups in moving to manage obstacles due to which their physical efficiency scores were better in the primary outcome. Moreover, the gait speed increased by 14% in combination group who were provided resistance and aerobic exercise intervention whereas it increased only by 7% above baseline in the separate groups (Villareal et al. 2017). The gait speed is referred to time taken by individuals in walking a specified distance on surface level (Bindawas, 2016). Thus, the result is useful to explain that increases gait speed which indicated better physical efficiency resulted individuals of combination group to show increased PPT scores compared to others.

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Implication of the results

The results gathered from the study of Villareal et al. (2017) can be effectively implemented in care intervention for adults suffering from obesity which reduced their physical efficiency. This is because involving them in the aerobic and resistance exercise apart from other weight-management intervention is going to enhance their physical efficiency long with reduce fat and body weight to allow them execute everyday actions by avoiding hindrance with obesity. The findings can be used in creating pragmatic implementation because Medicare for obese people considers use of behaviour therapy for weight loss which is leading to increased gym membership. The CASP framework asks to mention whether or not results from studies can be locally implemented. This is because without generalised implication of results it indicates that it can be widely used in support concerns (CASP, 2018). In the current study, the implication of the results is unable to be made locally. This is because most of the participants in the study were white women who were well-educated. It limits the implication of the result in general manner as there is biased consideration of gender in the study due to which its holistic impact on men cannot be identified. Moreover, results developed are limited to be implemented in non-educated environment as it does prove its successfulness with supportive evidence in the study. Further, implementation of the results in general condition is limited as it does not represent the obese population as whole. The results developed do fit in the wider literature by supporting the fact that aerobic and resistance exercise enhances mobility efficiency and fat loss in obese adults. However, use of either of the intervention is less effective in managing frailty and preservation of lean mass in obese adults.

Conclusion

The above discussion informs that randomised control trial is been used as research design for executing the research which acted as benefit or them to avoid unnecessary selection bias to be created. The critical appraisal of the study through CASP framework mentioned that results presented in the study are valid as the trial effectively addressed the key issue along with allocated sample in groups through randomisation in gathering results indicating following of effective protocol in presenting data. The primary and secondary outcomes of results are presented in the study which led to understand how the Physical Performance Test (PPT) scores among the combined group was more compared to other experimental groups and control group.

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