Saint Paul University Philippines

Tuguegarao City, Cagayan 3500

GRADUATE SCHOOL
School of Nursing and Allied Health Sciences
College of Nursing

Master of Science in Nursing

3RD TRIMESTER 2020-2021

RESEARCH CRITIQUE

In Partial Fulfillment
Of the Requirements for

ADVANCED ADULT NURSING 2

Submitted by:
JAY-ANNE RAPANO, RN
MSN Student

In the research article, The Effects of Exercise on Life Quality and Depression Levels of
Breast Cancer Patients, Mensure Aydin et al. (2021). Asian Pacific Journal of Cancer Prevention
outlines an experimental, comparative study, purposed to determine the effects of aerobic and
stretching exercises on quality of life and depression levels of breast cancer. Breast cancer has
been studied by many authors in different approaches and objectives worldwide to control
prevalence of breast cancer by strong and clear strategies such as breast self-examination.
The researchers have discovered that aerobic and resistance exercises improved quality of
life and decreased depression levels of women who previously received breast cancer treatments.
So the studies in this field try to understand the relationships between exercise therapy, quality of
life, and depression level of patient, we can consider it as a part of a wider study that relates to
breast cancer.
The problem statement is not clearly identified. It can be written this way: is there any
significant relationship between exercise therapy, quality of life and depression levels among
breast cancer patients. The problem statement is significant to nursing because it is adding new
knowledge to the nurse about the importance of exercise in the life quality in women who have
breast cancer. Nurses are greatly challenged to provide comfort and direction during a critical
time when women are initially diagnosed with breast cancer and receiving treatment.
The independent variables in the study were clearly defined. The independent variables is
the exercise procedures which includes aerobic exercise and home/resistance. Aerobic exercise is
performed 3 days a week, 50 minutes bouts. Program includes 10 minutes warm up, 30 minutes
walking and cycling and 10 minutes of cooling down. Treadmills and exercise bikes at fitness
center were used for the aerobic exercise. While Home Exercise includes resistance training to be
performed at least twice a week for 60 minutes. Program includes 10 minutes warm-up, 40
minutes leg and hip workout by using elastic band and ball and 10 minutes cool down. On the
contrary the dependent variables were not clearly defined in the study. Although it was mentioned
that Quality of life is a result of obtaining ideal body weight, cardiopulmonary fitness, decrease in
fatigue sense, neuromuscular integrity, increase in muscle strength and elasticity, and
improvements in psycho-social well- being. Whereas depression is the majority reaction when
being diagnosed of the disease. Statistical analyses were performed using Statistical Package for
the Social Sciences software. Numerical variables with normal distribution were given as mean
standard deviation, whereas, those having non parametric data as median and interquartile range,
the categorical variables as frequency and percentage. T-test and paired sample t-test were used
for numerical variables with normal distribution. For numerical variables with abnormal
distribution Mann-Whitney U and Wilcoxon test was used.
The effect of exercise program on the quality of life and depression level among women
with breast cancer is measured. The independent variable is the exercise program while the
dependent variables are quality of life and depression levels. So it’s relevant to the research
problem stated in the 1st part of this critique, since we are talking about physical and
psychological well-being so the role here is for the nurse make an effort to promote patient’s
quality of life, because the role of nursing is to care for patients, although there is no hypothesis
in this study. The mean to measure the variables are appropriate because the authors used World
Health Organization Quality of Life Scale, EORTC-QLQ-C30 Scale and Beck Depression
Inventory. These tools were used to evaluate quality of life and the severity of depression before
and after 12 week exercise programs.
The authors in this study, reviewed a sufficient amount of literature. They can define the
variables and the concepts of this study from different articles; Exercise, quality of life, level of
depression and she also represents different opinions like when she wrote the relationship
between the variables in which it is expected that being away from the hospital atmosphere, in a
safe and hygienic home environment, using their own equipment and doing exercise everyday,
would enhance subjects’ quality of life and reduce depression. The authors didn’t write her
literature review critically. They collects the literature from different sources. The author in this
study reviews primary sources and also the time interval of that literature collected ranged from
2005-2020.
The study was selected from individuals who were treated in Kocaeli University Medical
Faculty Hospital, Oncology Clinic and volunteered to participate in the study. The study
consisted of patients who were treated in hospital and who came for routine control who could
follow the program. The inclusion criteria included were patients who had undergone partial or
total breast surgery for breast cancer and who had not developed distant organ metastases who
agreed to participate in an exercise. Before initiating the study, all the participants were informed
about the study procedure. A written informed consent was obtained from each participant and
they were instructed to stop exercise in case of any adverse event. The study protocol was
approved by the Ethics Committee. A total of 48 women who were previously diagnosed with
breast cancer and completed their treatment with no metastasis were included in the study. The
sample was two group, first 24 women who received the exercise program were assigned as the
study group, while the remaining 24 women who did not receive the exercise program were
assigned as the control group. The demographic features of the exercise and control group were
the same in patient’s age group was 55-60 and housewives. While it differs in terms of
educational, occupational and economic status. As mentioned earlier questionnaire tool were used
to evaluate the quality of life and level of depression of the study group.
 The sample was suitable to the aim of study “to determine how the aerobic and stretching
exercise programs influence the quality of life and depression levels of the breast cancer patients
who completed their treatment. As the authors is talking about breast cancer and the incidence of
this disease increased in women more than men; also the author includes the age of women;
because breast cancer risk increase with age.
The authors in this study used an experimental, comparative design, and this design is
appropriate to answer research questions because the author also used a convenience sample
which is meant that there were specific characteristics required to answer specific questions
which are related to the women’s physical and psychological responses and the well-being of
women with breast cancer, as the author aimed. There was one control group for the study to
compare with the exercise group.
The author takes limitations into account as a recommendation for further exploration
such as other areas that need further exploration. Aerobic and resistance exercises are commonly
studied, however, while there are studies looking at combination of two exercises, few of these
were seen to study home-based resistance exercises. Moreover, five days or more times a week
and safe and feasible exercise programs are found to be less common in the literature so further
exploration is recommended.
Reliability and validity of this study was accomplished by the following information and
calculations. In using WHOQOL-BREF quality of life scale, a significant difference has been
found in all parameters of the group participating in the study. The study and control group
comparison wherein there was a significant difference in general health (p=0.001), physical
health (p=0.001), psychological health (p=0.009), social health (p=0.016) environmental health
(p=0.002) parameters. While in using EORTC-QLQ-C30 quality of life scale, the functional
parameters of the group participating in the exercise program, a significant difference has been
found in physical (p=0.011), role (p=0.039), emotional (p=0.031), social areas (p=0.010). More
items means more reliability but not too long. The internal consistency reliability for the quality
of life. A significant difference has been found in the depression scores of the study group before
and after the exercise program (p<0.001). Beck depression inventory scale shows the result for
the depression levels of the study group and control group was found to be significantly different
from each other (p<0.001).
The discussion part fits with the data because the authors discuss all variables that have
been analyzed and they mentioned the important finding of the study such as the mediating effect
of the exercise program concept on quality of life and level of depression. The study showed that
according to EORTC-QLQ-C30 quality of life scale, exercise positively affected functional
parameters (physical, social, and life quality), symptoms (loss of appetite, fatigue, sleep disorder)
in breast cancer patients. In patients who were assigned exercise program, significant
improvements were observed in several subscale parameters of WHOQOL-BREF quality of life
scale, namely, general, physical, and psychological health, social, and environment. According to
BDI results, it was observed that depression levels were reduced in the study group. Findings of
the study concluded that there were significant differences between the exercise and non-exercise
groups (in terms of depressive symptoms) so that an applicable exercise program should be given
to breast cancer patients after the treatment. The study also showed that depression levels of the
study group decreased (p=0.001) remarkably as a result of the exercise while depression levels
increased in control group who did not perform any exercise. In conclusion, this study showed
that aerobic and resistance exercises improved quality of life and decreased depression levels of
women who previously received breast cancer treatments.
In this study and in my opinion I see that the use of variables are clear and sufficient; also
it represents the significance of the study The literature review is sufficient, and design fits the
research problem; the implications and limitations are clearly defined. All these are strong points.
The weak points, in my opinion is as follows: the research problem, hypothesis and research
question weren’t directly mentioned, the literature review wasn’t written critically, using
convenience sampling for this study.
The author mentioned recommendation to regular exercise for it improves physical
function, aerobic capacity, strength and flexibility as well as boosts the immune system of the
cancer patients. Nursing should provide holistic care by encouraging women diagnosed with
breast cancer to explore aspects of spirituality that are important to them. Additionally, nurses
should assist women in examining their feelings, such as meaninglessness or loneliness, which
are affecting their sense of physical or psychological well-being, and these recommendations
should be appropriate to nursing to improve the quality of life of patients and give them positive
effects on health that include physical psychological response.
The findings support healthcare providers encouraging of women diagnosed with breast
cancer to use exercise therapy as an effective means for dealing with the physical and
psychological responses to cancer. Nurses should provide holistic care by encouraging women
diagnosed with breast cancer to explore aspects of physical activity that are significant to them.
Additionally, nurses should assist women in examining their feelings, such as meaninglessness or
loneliness, that are affecting their quality of life and the findings support healthcare providers
encouraging women diagnosed with breast cancer to explore exercise regimen that suits them to
manage the depression cause by having a cancer..
 This article gives me an idea for further research in which using the exercise regimen to
other type of cancer patients. What would be the effect of exercise on life quality and depression
level of other type of cancer?