review assistance

Yuritza Medina

Chamberlain College of Nursing

NR709 Project and Practicum IV

Summer 2022

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 common but chronic condition has been for a long time a public health concern and social determinant. 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. 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.

Results and Discussion: 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. What were the key themes?

Conclusions and Further Recommendations:  This systematic review supported the effectiveness of the AHA Diet and Lifestyle recommendations to prevent and reduce obesity, and clinical use 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.

In dedication to my family for their steadfast 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.

First, I must acknowledge the help of all my professors from Chamberlain University, 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 Dedication 3 Acknowledgments 4 Introduction 6 Problem Statement 7 Significance of the Practice Problem 7 Theory or Translational Science Framework 8 Methodology 10 Review Protocol 10 Inclusion/Exclusion Criteria 11 Results and Discussion 13 Characterization of the Body of Literature 13 Findings Synthesis 15 Conclusions and Further Recommendations 20 Implications for Nursing Practice 20 Conclusions and Contributions to the Professions of Nursing 21 Recommendations 22 References 23 Appendix A 28

1

5

The entire paper needs to be in past tense – this is a retrospective review of the literature on your evidence based intervention

Obesity is a global epidemic that impacts an estimated 650 million individuals worldwide, causing 2.8 million deaths annually (WHO, 2021; CDC, 2021). Despite efforts to prevent and manage obesity, the numbers are still increasing, and in the USA alone, more than 300,000 deaths are recorded yearly (CDC, 2021). Also is devastating the emotional, social, financial, and other implications that this serious health concern has at a patient, community, national, and international level. The AHA recommends lifestyle interventions that can reduce the prevalence of obesity and make people live within the clinically appropriate weight (Bray & Ryan, 2020). The recommendations are found in literature and practice, but few researchers have analyzed the literature on the effectiveness of these interventions.

Wearables and smartphone applications provide new ways to improve physical activity habits (Gal et al., 2018), and researchers have further acknowledged technology's role in enhancing these interventions' outcomes. This integrative review presented quality and credible sources that established evidence of the efficacy of the AHA Diet and Lifestyle recommendations to reduce and prevent obesity in adult patients. Also, the role of wearable trackers and mobile applications and what can be done to enhance the effectiveness of these interventions were analyzed. The review started by defining the problem, its significance, and the translation framework that served as its foundation. The DNP student discussed the methodology, capturing the review protocol, how studies were included or excluded, and how data was analyzed. Further, the DNP student characterized the body of literature used in the review and later synthesized findings that informed the recommendation of the AHA lifestyle interventions to reduce weight.

Obesity represents a common but preventable cause of morbidity and severe medical complications (WHO, 2021). Despite efforts to curb the issue, globally, the annual cases of obesity continue to rise, affecting people's health (CDC, 2021; Carbone et al., 2022). According to the literature, for patients with obesity or a sedentary lifestyle, physical activity and a healthy lifestyle are advised to minimize the risk of chronic diseases such as diabetes, cardiovascular disease, and cancer (Lavie et al., 2019). The easy availability of sophisticated activity trackers such as Fitbit offers a unique opportunity to use it to improve physical activity habits (Gal et al., 2018). 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 was: 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?

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).

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 the USA $190.2 billion in 2018, accounting for 21% of healthcare expenses. The government continues investing much money in healthcare institutions to provide the most excellent care to patients, and the economic implications are enormous.

At the community level, obese patients experience difficulties managing the physical, emotional, and financial pain associated with obesity. Financially, community members spend a lot on treating and managing the disease. The frequent hospital admissions have caused financial implications because they do not go to work often. Some have to incur an extra financial cost because they need to employ a caregiver at home. The disease is emotionally draining, and patients are at increased risk of developing panic disorder, bipolar disorder, and major depression. The number of obese patients at the clinical site was significant, calling for an innovative intervention to reduce obesity and enhance clinical outcomes.

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 helps stakeholders utilize the facilitators and address the barriers. The facilitators include a cooperative patient care team, and the potential wall is that 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 use knowledge . The step involves mapping and applying the AHA diet and lifestyle recommendations and using 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).

The search for appropriate literature was centered on key terms, concepts, and phrases, including obesity care, physical activity and obesity, lifestyle implications, and activity trackers. The primary databases where the resources were drawn are Chamberlain Library, CINHAL, and PubMed. Studies conducted for the preceding 4-5 years were included in the search. During the initial search, 20000 articles were found, and only 45 were selected based on the relevance and availability of the entire study online for further examination. The 45 studies were then filtered down to 15 more appropriate studies to answer the PICOT question.

The search started by defining the PICOT question and narrowing it down to the focus: The AHA lifestyle recommendations and obesity. After having searchable questions, the keywords and phrases that can express the two concepts were determined. A concept map was then developed to guide the search process by showing the relationship between the key terms or concepts in the PICOT question. After defining the searchable question and having the relevant keywords, phrases, and concepts, the databases with a broad range of evidence were determined, and the search process began.

The search strategy accounted for all possible search terms, keywords, and key phrases that could help yield results that answer the PICOT question. The search was done using keywords, exact phrases, and adjacency which yielded more relevant results. Article titles were also used to search for known key papers used in developing the project plan. At the end of the initial search, many results were produced, and the next step was to make the search comprehensive. The appropriate filters, relevance, and currency were used to filter the yield and arrive at the 15 articles used for the review. Comment by McGonigal, Shelly (AHN): What were the appropriate filters? This section is good but lacks detail into how you filtered/adjusted key terms to get to 15

The types of studies and levels of evidence played a significant role in determining what should be included in the study. The project relied on levels I, II, and III of evidence to get high-quality and justifiable findings based on high-quality research designs. The types of evidence included in the review can be grouped into the following: experimental studies, RCTs, Systematic Analyses and Meta-analyses of RCTs, and observational studies. These study designs yield objective, high-quality information that can be successfully implemented. Evidence from opinions and single descriptive studies were excluded from the study. Comment by McGonigal, Shelly (AHN): This section is good - just need more detail What years did you include/exclude; demographics? Full text? Journals? White Papers? Etc. Comment by McGonigal, Shelly (AHN): This is an integrative review - not a study - please adjust

The studies included in this review are those with realistic, practical recommendations. The recommendations must be aligned with the investigated problem and whether the interventions can be implemented successfully in terms of dosage, method of implementation, and the time it takes to implement the intervention. For example, it may be unrealistic to recommend interventions that take more than five years to evaluate and determine outcomes. Studies whose recommendations seemed unrealistic or required too much time for implementation were excluded.

The last criteria were credibility, currency, and relevance. The study included sources that have been published in credible journals and credible authors. They must also be relevant because their findings directly relate to the project problem. Lastly, the sources were analyzed in terms of currency to ensure the data extracted are current and can be used to address current problems. Sources whose credibility was questioned, published more than five years agow, and do not directly address the PICOT question were excluded. Comment by McGonigal, Shelly (AHN): Need years...

After defining the question and identifying studies that meet the criteria for review, data were extracted by reading through the studies and summarizing the relevant findings. While reading through the studies, it was essential to identify any possible biases that would compromise the quality of the study. During summarization, the meaning was attached to the findings through critical interpretation, and the summary findings were input into the John Hopkins evidence table for easy analysis. Comment by McGonigal, Shelly (AHN): Did you use a tool for the analysis of the articles? John Hopkins Nursing evidence based practice tool? Good work - just light on detail.

After all the data was extracted, a qualitative approach was used to analyze the findings. The approach involves collecting descriptive, non-numerical data to help understand experiences, concepts, experiences, and opinions. The qualitative approach was used to gather in-depth insights into the problem and generate ideas to help address the PICOT question. The choice of qualitative data analysis was informed by its ability to define critical points from several studies and summarize them into meaningful data. Qualitative analysis also gives room for in-depth examination, a feature that may not be present in quantitative analysis (Agunis & Solarino, 2019). Through qualitative data analysis, the review yielded findings related to the effectiveness of AHA recommendations, the use of technology, and factors that can influence better intervention outcomes.

A thematic analysis approach was used to analyze the data and generate results from themes relevant to the project. The analysis was conducted in three main steps; familiarization with data, identifying common themes across several studies, grouping all the findings related to specific themes, and putting down all the findings in a synthesis form. The approach is advantageous because it enables one to understand the patterns in data and find relevant findings that will address the research problem. It is also a straightforward approach that consumes less time.

The integrative review was based on high-quality resources, credible research designs, appropriate participants, and realistic and ethical recommendations. The evidence types included experimental designs, RCTs, systematic reviews, and observational studies. The sources were published in credible sources, including the American Association of Nurse Practitioners, the American Psychological Association, the Journal of Digital Health and Open Science, and the Journal of Public Health.

The literature sources were drawn from Chamberlain Library, CINHAL, and PubMed. The three were chosen because of their credibility, as most of the articles in these databases are authentic. After the initial search, about 2,000 articles surfaced, which called for further review to come up with sources that addressed the PICOT question. Therefore, the DNP student narrowed the search to key terms and concepts and exact phrases so that the results were filtered to more relevant ones. After using keywords and phrases, the search was filtered to 45 papers only. Further, other mechanisms such as type of research design, currency, and relevance to the project were used to review, and in the end, 15 sources were used for the review. The DNP student felt the 15 would better address and answer the PICOT question.

The Strengths of the resources were examined, and it was found that the sources used for the integrative review are credible, authored by professionals, and published in trusted journalsw. They provided comprehensive, precise, and reproducible data that stated measurable outcomes. In all the sources, the observable outcomes were evident. Comment by McGonigal, Shelly (AHN): Which journals?

The review relied on RCTs that test the relationship between cause and effect. The findings from the RCTs have minimal bias and help to establish a direct outcome of the lifestyle interventions. RCTs also administer interventions in a controlled way which enhances the effectiveness of the research.

The studies were based on reliable data collection and analysis methodologies, contributing to the research's overall quality. The studies were analyzed using statistical methods or qualitatively and bore insightful results. Strict eligibility criteria were used to ensure that the sources used were credible and of high quality. Only studies levels I, II, and III were used, implying that the findings are credible.

The weaknesses of the resources were examined, and it was found that one of the most common limitations of studies is the risk of subjective bias at different stages of the research. The sources are evidence of subjective biases during study design, data collection, and analysis. Some systematic errors may affect the quality of the studies.

Most studies were conducted in specific populations, making it challenging to generalize and apply the findings in a different setting. It makes it challenging to establish the extent to which the results can be applied in a broader context. As a global problem, obesity should be approached from a broader perspective. The results of a specific population in one part of a country may not represent all the patients.

Detail is required – Check on page requirements – this section appears to be short. More specifics…

The studies yielded significant evidence that helped to answer the PICOT question and what can be incorporated in practice to enhance healthy living and boost the quality of life. Researchers have identified lifestyle interventions and practices that can be implemented to prevent and manage obesity. Research done by Balani et al. (2019) points out that self-regulation is the first step to managing weight and living healthily. Self-regulation entails consuming the right amount of food at the correct intervals to avoid being overweight. Wadden et al. (2020) share the same sentiments and maintain that people who regulate the amount of food intake are likely to be healthier and prevent obesity and other diseases associated with lifestyle. Such patients are less vulnerable to obesity, especially if they are free from other linked factors, such as genetics. Comment by McGonigal, Shelly (AHN): Integrative review Comment by McGonigal, Shelly (AHN): What were the key themes from the articles - synthesize the findings

Researchers also emphasize that food intake self-regulation, coupled with physical activities, is likely to enhance the quality of life. In their study, Wadden et al. (2020) also mention that engaging in physical activities, such as exercising, leads to long-term weight loss, making people healthier and less obese. As people exercise, they burn calories in the body, which results in weight loss. The findings are emphasized by Swift (2018), who reveals that exercising and training have solid clinical significance and reduces obesity. For people who are already battling medical issues, exercises and training exercises help manage the issue. However, Beauchamp (2018) insists that patients should be monitored and supported to enhance outcomes. In his study, Beauchamp reveals that patients who are supported and monitored are more likely to adhere to healthy behavior than those who are not monitored or supported. Monitoring also helps to identify any issues that may hinder effectiveness and address them as soon as possible.

Evidence from the sources also shows that lifestyle interventions are significant in weight management, and implementing these interventions contributes to healthy living in the community. Jerome (2019) conducted a study that revealed that lifestyle modifications are clinically significant and reduce incidences of obesity when implemented appropriately. Balani et al. (2019) conducted an online survey that revealed that people who regulate food intake in their bodies are in a better place to attain and maintain a clinically appropriate weight. In a different study, Bergum (2021) mentions that lifestyle interventions reduce blood pressure and control weight gain. Patients who can control weight automatically become less vulnerable to obesity. However, these researchers also raise concerns about the effectiveness of lifestyle interventions on obesity, saying that they may not directly affect the amount of cholesterol in the body. The concerns are built on the basis that the effectiveness of a lifestyle intervention depends on many other internal and external factors.

Jiang (2022) also found out that patients who receive lifestyle interventions reduced the risk of obesity and enhanced their quality of life. While Wadden et al. (2020) acknowledge the role of physical training in weight management and long-term weight loss, the researchers found that patients require face-to-face sessions where they are counseled and motivated to remain on track. The researchers mention that online monitoring is less effective because it encourages non-adherence, and patients may not report the actual progress. When patients meet in a physical setting, they exchange ideas and progress, challenging each other to stay on track. On their part, Swift et al. (2018) challenge patients to incorporate diet and physical activities together, saying they are more effective when implemented together compared to when either of them is implemented. Swift and colleagues also argue that 150 minutes and 75 minutes for moderate and vigorous exercise are insufficient to make a clinical difference.

Lean et al. (2018) also conducted a study that revealed that dieting and physical activities significantly prevent and manage type 2 diabetes. The researchers conducted a Randomized Control Trial (RCT) where more than half of the participants recorded positive results after 12 months of an intensive weight management program that included physical activity and dieting. After the program, these patients attained remission of type 2 diabetes and were freed from antidiabetic drugs. Therefore, the researchers concluded that lifestyle health management effectively prevents and manages lifestyle diseases. In a randomized control trial conducted by Groessl (2019), physical activity intervention addresses long-term negative implications associated with obesity, such as reduced mobility; obese patients who engage in physical activity are less likely to experience mobility issues compared to those who do not. The researcher mentions that while patients may have trouble treating obesity thoroughly, they can manage obesity-related complications through healthy lifestyles.

Apart from dieting and physical activities, researchers have acknowledged the significance of technology in using the AHA recommendations to manage weight and attain a high-quality life. As the healthcare system embraces technology, researchers also continue to assess how patients can benefit from the latest technological tools and applications. One of the technological tools is wearable trackers that have positive and negative effects on implementing AHA recommendations. According to Brickwood et al. (2019), patients who use wearable trackers when exercising are likely to increase their step count over time as they get motivated. However, according to the study, the motivation will depend on other internal and external factors, such as tolerance, state of mind, and weather conditions. For example, patients with a high tolerance are more prone to continue working than those with a low tolerance. Similarly, poor weather conditions, like a rainy evening, may discourage a patient from jogging. In the same study, the researchers revealed that wearable trackers increase monitoring, enhancing patients’ ability to monitor their progress.

Following et al. (2019) conducted a qualitative study that identified trackers as enhancers and distracters in patients’ participation. According to the researchers, the trackers act as either success or failure proof which may motivate or demotivate patients. When a tracker records positive progress, patients will likely be motivated and continue with the interventions. Similarly, a systematic review conducted by Gal (2018) shows that wearable trackers and phone applications are practical tools that encourage patients to continue exercising and training through successful monitoring. On the contrary, patients may stop exercising if the tracker records zero or negative progress. The researchers recommended individualized trackers that meet clients’ needs to avoid discouragement. Gal et al. (2019) revealed similar results: a tracker can promote or inhibit physical activities among patients. Gal and her colleagues recommend that patients have other forms of support and motivation to maintain a healthy lifestyle.

The two preceding studies acknowledge that trackers can promote engagement in physical activities, but they depend on other external factors. Therefore, it is crucial to check on all factors before ascertaining the impact of the trackers. For example, clients who are less willing to use the tracker may yield minimum benefits even when they use them. The aspect of willingness and acceptability has been researched by Vandelanotte et al. (2020), who reveal that clients’ acceptability and willingness to track their progress enhances or reduces intervention outcomes. More willing and accepting users are more likely to benefit from the trackers than those who are unwilling. The authors, therefore, challenge patients to embrace trackers and use them appropriately to be a source of motivation. On his part, Hu (2021) maintains that connectivity also determines the outcomes of the interventions concerning patients’ ability to stay in touch with mentors who keep engaging them and updating their progress. However, he maintains that self-tracking apps are easy to use, and if patients are willing, they will register positive outcomes.

Researchers went further to determine the internal and external factors that may enhance the outcomes of lifestyle intervention. These factors are likely to make a positive difference when incorporated into practice. In research conducted by Balani et al. (2019), patients' attitudes and nutrition knowledge affect their ability and willingness to stay committed to intervention programs. Patients knowledgeable about nutrition and have positive attitudes toward weight management are likely to be more committed to the programs and achieve positive results. The study authors, therefore, challenge healthcare institutions to invest in patients’ knowledge and attitudes which they believe will enhance outcomes. In another study, Ma (2017) attributed the lack of positive outcomes to a lack of or poor assessment, which demotivates patients and makes them return to their unhealthy lifestyles. The researcher argues that frequent evaluation of the interventions will help keep patients on track and enhance outcomes and determine any gaps that can be fixed to enhance outcomes.

Primary clinics should incorporate the AHA recommendations as part of the treatment plan protocols to enhance patient outcomes. Healthcare professionals should educate patients on the importance of healthy living and provide them with the necessary support, such as remote monitoring, to ensure they can sustain positive outcomes. There should be efforts that enhance adherence, such as personal sessions to encourage the patients to eat appropriately and engage in physical activities to attain and maintain an appropriate weight. By doing this, patients' overall quality of health will improve, and they will incur fewer costs in treating and managing diabetes.

In nursing care, there should be efforts to address obesity by incorporating diet and healthy lifestyle recommendations, such as offering patients the right nutritional foods with the right amounts of calories needed. There should be time for physical activities, such as evening walks, as patients can improve their general quality of life and treatment outcomes. Nursing care today should be done holistically, meeting patients' physical, mental, nutritional, and emotional needs to avoid over-relying on medications alone which, in some cases, may not register positive outcomes. These efforts will result in reduced hospital stays, enhanced patient outcomes, and better job satisfaction among healthcare professionals.

At the organizational level, healthcare institutions should embrace lifestyle interventions and develop treatment plans incorporating lifestyle aspects to cut costs. Remote monitoring of patients about adhering to lifestyle intervention should also be implemented to reduce admission rates and hospital check-ins, as this will reduce daily hospital costs. Therefore, facilities should embrace technology and utilize modern tools to improve telehealth and reduce costs while maximizing outcomes.

Check the requirements for this section – micro/meso impact?

Obesity is a significant individual, community, national, and global healthcare problem. According to research, lifestyle interventions effectively manage appropriate body weight and prevent obesity (Wadden et al., 2020). People who implement dieting and physical exercises are more likely to achieve long-term weight loss than those who do not (Swift et al., 2018). The integrative review found that incorporating regular physical activity and a healthy diet help to diminish multiple medical issues connected with obesity (Bray & Ryan, 2020), reducing the expenses associated with obesity treatment for organizations, which improves clinical results and nursing care.

This systematic review supported the effectiveness of the AHA Diet and Lifestyle recommendations to prevent and reduce obesity, and clinical use is recommended as an innovative solution. The lifestyle recommendations are practical, as Bergum et al. (2018) revealed that patients who incorporate healthy eating and exercise register low body weight. However, the interventions are more effective if followed by face-to-face counseling to enhance outcomes (Wadden et al., 2020). Interventions are also more effective than dieting or physical exercises alone (Swift al., 2018). Swift is further concerned that 150 minutes for moderate exercise and 75 minutes for vigorous are inadequate to make a clinical difference.

Researchers further acknowledged technology's role in implementing AHA diet and lifestyle recommendations. Clients who use wearable trackers become more motivated and register more steps in physical exercise (Brickwood et al., 2019). Similarly, Gal et al. (2019) and Vandalanotte et al. (2020) reveal that wearable trackers enhance engagement in physical activity. However, the researchers further show that wearable trackers are more effective if patients are willing to use them and if they can access customized trackers that meet their needs.

· Healthcare professionals and other stakeholders should educate patients on the importance of lifestyle interventions to enhance their acceptability of dieting and physical activity.

· Nurses should incorporate lifestyle interventions in their daily care plans to enhance treatment outcomes.

· Patients should also embrace healthy living as a prevention and management mechanism for obesity and other lifestyle-related diseases. They should be committed to the intervention to enhance intervention outcomes.

· Patients should embrace wearable trackers and mobile applications to help them monitor their physical activity progress and use them as a motivation to adhere to healthy living.

· Future researchers should consider examining the effectiveness of the knowledge-to-action implementation model in implementing AHA recommendations for obesity prevention and management. Examining this model will help establish the most appropriate population for this implementation approach.

Johns Hopkins Nursing Evidence-Based Practice

Individual Evidence Summary Tool

© The Johns Hopkins Hospital/Johns Hopkins University. It may not be used or reprinted without permission.

Date: 11/10/2022