PICOT and Literature Evaluation Table

GCU Literature Evaluation Table

Student Name:

Summary of Clinical Issue (200-250 words):

PICOT Question: In middle aged hypertensive and overweight adults, does lifestyle modification in the form exercise and diet changes result in weight loss and reduced blood pressure within 12 months.

PICOT and Literature Evaluation Table

Criteria Article 1 Article 2 Article 3
APA-Formatted Article Citation with Permalink Herrod, P., Doleman, B., Blackwell, J., O’Boyle, F., Williams, J. P., Lund, J. N., & Phillips, B. E. (2018). Exercise and other non-pharmacological strategies to reduce blood pressure in older adults: a systematic review and meta-analysis. Journal of the American Society of Hypertension: JASH, 12 (4), 248–267. Alsinani, T. S., Abdullah, A. A., Alghamdi, T. A., Alsaigh, S. A. S., Alanazi, M. D., Alkahtani, M. A., Alzahrani, T. A., & Alabdrabalrasol, E. A. (2018). Lifestyle modifications for hypertension management. The Egyptian journal of hospital medicine, 70(12), 2152-2156. Lee, C. J., Kim, J. Y., Shim, E., Hong, S. H., Lee, M., Jeon, J. Y., & Park, S. (2018). The effects of diet alone or in combination with exercise in patients with prehypertension and hypertension: a randomized controlled trial. Korean circulation journal, 48(7), 637-651.
How Does the Article Relate to the PICOT Question? This study looks at the strategies that reduce blood pressure such as exercise This study looked into the many lifestyle changes that a patient can do to maintain and control blood pressure and improve their quality of life. This article was to assess the efficacy of a home-based lifestyle change intervention on blood pressure control.
Quantitative, Qualitative (How do you know?) qualitative study Publication views are analyzed. Qualitative study It displays views of other different studies Quantitative since blood pressure measurements are analyzed.
Purpose Statement To display non-pharmacologic strategies that reduce blood pressure To ascertain that lifestyle modifications are effective in management of hypertension Assess the effectiveness of the combination of diet and exercise interventions in lowering blood pressure
Research Question How do non-pharmacological strategies lead to blood pressure reduction? Are lifestyles modifications effective at controlling blood pressure? Is the combination of exercise and diet effective in lowering blood pressure?
Outcome In elderly people, an exercise-based lifestyle intervention may result in a 5/3 mm Hg drop in blood pressure. Isometric exercise has the potential to be more beneficial. with modification of lifestyles, hypertension is effectively managed Diet and exercise-focused lifestyle changes were helpful in decreasing blood pressure and should be preferred over diet-only changes.
Setting (Where did the study take place?) Community setting Community setting The study is home based
Sample 5139 participants with a mean age of 69 articles published from 1976 through February 2017 85 patients aged over 20 years with prehypertension and mild hypertension
Method Systematic review of randomized controlled trials Randomized controlled trials Randomized controlled trial
Key Findings of the Study Non-pharmacological interventions lead to a better control of blood pressure application of most lifestyle modifications leads to a greater control of blood pressure For effective blood pressure lowering, both active dietary and activity interventions are required.
Recommendations of the Researcher Hypertensive patients should be encouraged to practice these non-pharmacological interventions for better control of blood pressure Health professionals should educate and encourage patients to undertake the modifications because of the benefits. A combination of diet and exercise should be implemented instead of a single modification
Criteria Article 4 Article 5 Article 6
APA-Formatted Article Citation with Permalink. PICOT and Literature Evaluation Table   Mahmood, S., Shah, K. U., Khan, T. M., Nawaz, S., Rashid, H., Baqar, S., & Kamran, S. (2019). Non-pharmacological management of hypertension: in the light of current research. Irish journal of medical science, 188(2), 437–452. Aronow, W. S. (2017). Lifestyle measures for treating hypertension. Archives of medical science: AMS, 13(5), 1241. Yang, M. H., Kang, S. Y., Lee, J. A., Kim, Y. S., Sung, E. J., Lee, K. Y., Kim, J. S., Oh, H. J., Kang, H. C., & Lee, S. Y. (2017). The effect of lifestyle changes on blood pressure control among hypertensive patients. Korean journal of family medicine, 38(4), 173.
How Does the Article Relate to the PICOT Question? The study looked at the importance of non-pharmacological management of blood pressure The study focused on the Lifestyle measures that can be used to control blood pressure The article assessed how lifestyle changes affect control of blood pressure among the hypertensive patients.
Quantitative, Qualitative (How do you know?) quantitative Pretest and posttest blood pressure values are obtained Quantitative Results are in numerical form Qualitative
Purpose Statement Emphasizing the effectiveness of lifestyle modifications strategies in blood pressure control To identify the effectiveness of the lifestyle modification strategies in treating blood pressure Suggest factors and lifestyle changes linked to blood pressure control in patients on antihypertensive medications.
Research Question How effective are the non-pharmacological interventions in control of blood pressure? How do different lifestyle modifications contribute in treating blood pressure? Which lifestyle factors contribute to increased blood pressure and how can they be modified to control blood pressure?
Outcome Assuming multiple non-pharmacological interventions lead to effective control of blood pressure Lifestyle measures like reduced salt intake and exercise lead to blood pressure control sex (OR, 3.55; 95% CI, 2.02 to 6.26; P<0.001), salt intake (OR, 0.64; 95% CI 0.43 to 0.97; P=0.034), and comorbidity (OR, 1.82; 95% CI, 1.23 to 2.69; P=0.003) were associated with successful blood pressure control
Setting (Where did the study take place?) Community setting Community setting and clinical centers hospital setting
Sample 6779 hypertensive patients A total of 206316 participants 1453 hypertensive patients on candesartan with 64 years as the average age
Method randomized control trials Randomized controlled trials Observational study Survey using questionnaires
Key Findings of the Study combination of multiple non pharmacological interventions lead to significant control of blood pressure Lifestyle modifications contribute a greater percentage in the treatment of hypertension Lifestyle factors that lead to hypertension can be modified to control blood pressure
Recommendations of the Researcher several non-pharmacological interventions should be combined for effective management of blood pressure Lifestyle changes should be used to prevent prehypertension and also in treating mild hypertension Doctors should advise patients on lifestyle modifications in inclusion of the antihypertensive.


Summary of the Problem

Hypertension can be defined as a situation where the blood exerts too much pressure against the arterial walls. It is described as having a blood pressure of more than 140/90, and severe if the pressure is higher than 180/120 (Yang et al., 2017). Overweight is a weight that is higher than what is deemed acceptable, as indicated by the body mass index (BMI). Lifestyle modification is changing long-term behaviors, such as eating or exercising, and sticking to the new routine.

Obesity and hypertension are some of the diseases that can be managed effectively through lifestyle changes. According to Alsinasi et al. (2018), factors that increase and complicate hypertension are mostly linked to poor lifestyle behaviors such as sedentary lifestyle and unhealthy eating habits. For example, a sedentary lifestyle where the food consumed has a lot of fat and lack of exercise predisposes one to hypertension.

Simple modification of these factors can potentially alleviate suffering in hypertensive patients. Interventions such as engaging in aerobic exercises lead to weight loss as the exercise helps burn excess fat deposited in blood vessel lumens. This increases the lumen size, thus reducing blood pressure. Diet changes also lead to blood pressure control. Reduced salt and fat intake play a significant role in controlling blood pressure (Mahmood et al., 2019). Other modifiable risk factors include the limitation of alcohol intake and stress management. These interventions are vital in controlling blood pressure in addition to taking antihypertensive.

Literature Evaluation Table Example 2

Student Name: 

Summary of Clinical Issue (200-250 words): Congestive heart failure (CHF) is a complex clinical syndrome resulting from impaired heart functioning, either due to structural or functional abnormalities. The cardiac abnormalities result in impaired filling or ejection of blood from the heart (Bay et al., 2018). As a result, vital peripheral organs, including the brain, kidneys, adrenals, and liver, have limited blood supply and hypoxia, leading to cellular injury and organ death. The functional and quality of life of patients with CHF are reduced due to impaired heart function.

CHF is a healthcare concern due to morbidity, mortality, and increased cost of care for CHF patients. Globally, it is estimated that up to 26 million people suffer from CHF, while America alone contributes to 5 million cases. Most of these patients require continuous hospital care and modification of management. Management of CHF requires multidisciplinary interventions to improve quality of life and reduce mortality.

Management entails the use of specific medications and lifestyle modifications. Medications include diuretics, cardiac glycosides, antihypertensives, vasodilators, and angiotensin receptor blockers (Du et al., 2018). Lifestyle modifications include weight reduction, low dietary salt intake, and aerobic exercise. Aerobic exercise has been used in various settings, leading to improved clinical outcomes, reduced hospital visits, and reduced admissions due to CHF-related complications (Gentili et al., 2021).

However, there have been increased hospital visits and admissions for CHF exacerbations and complications globally in recent years. Likewise, our emergency department has been overcrowded with CHF patients. Most of the patients reported adhering to their medications, yet they still have reduced quality of life. To expound on this issue and improve patient care, I came up with the following PICOT question.

PICOT Question: In patients with congestive heart failure (P), how does management using medications and exercise (I) compared to using the medicine without exercise (C) lead to a reduced emergency visit and hospital admission (O) over 12 months (T)?

Criteria Article 1 Article 2 Article 3
APA-Formatted Article Citation with Permalink  


Bay, A., Sandberg, C., Thilén, U., Wadell, K., & Johansson, B. (2018). Exercise self-efficacy in adults with congenital heart disease. International Journal of Cardiology. Heart & Vasculature, 18, 7–11. https://doi.org/






Du, H., Newton, P. J., Budhathoki, C., Everett, B., Salamonson, Y., Macdonald, P. S., & Davidson, P. M. (2018). The Home-Heart-Walk study, a self-administered walk test on perceived physical functioning, and self-care behavior in people with stable chronic heart failure: A randomized controlled trial. European Journal of Cardiovascular Nursing: Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 17(3), 235–245. https://doi.org/





Gentili, F., Cafiero, G., Perrone, M. A., Bianco, M., Salvati, A., Giordano, U., Silva Kikina, S., Guccione, P., De Zorzi, A., Galletti, L., Drago, F., Leonardi, B., & Turchetta, A. (2021). The effects of physical inactivity and exercise at home in young patients with congenital heart disease during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 18(19), 10065. https://doi.org/






How Does the Article Relate to the PICOT Question? Exercise is a component for patients with CHD, helps to improve muscle endurance and self-efficacy behavior, improves the quality of life compared to those that only manage with medication treatment. Exercise complements medications that reduce health complications, therefore, hospital visits. Self-care management for patients with CHF implementing Home-Health-Heart-Walk study monitoring and testing the physical component and behaviors. The self-monitoring process and self-care behavior improved with the physical activity. CHF patients improved self-care with self-management activities, which was noticed during three to six months of follow-up visits. Physical activity impacts pediatric CHD patients during COVID-19, and the impact of the low tolerance of physical activities and health complications is due to increased BMI and health risk factors compared with one year prior studies.


Quantitative, Qualitative (How do you know?) The study was Quantitative because of the statistical data provided by 79 adults and 42 matched controls.

On the other hand, the study is Qualitative because of the non-numeric data used in the research.

Quantitative, 132 patients.

Qualitative, CHF patients in HHW study.

Quantitative, 880 patients.

Qualitative, 16-18 years old.

Purpose Statement Patients with CHD combine medication and exercise strategies considering age, self-efficacy behavior, and health condition to improve quality of life. HHW study impacts stable CHF patients, self-care management, and physical outcomes. Decreased level of physical activities on these patients with CHD during COVID-19 lockdown and its consequences on health outcomes. 
Research Question What are the factors that influence low ESE in adults with CHD? What is the physical and behavioral impact of the HHW study on stable CHF patients? Did the decrease in physical activities for CHD pediatric patients have an impact on their health outcome due to COVID-19 restrictions.
Outcome Age and muscle endurance are related to exercise low self-efficacy. Multidisciplinary effort and exercises strategies improve the outcomes. Visible physical function improvement was not seen in CHF-stable patients; self-care management, efficacy, and monitor behaviors improved. Regular physical activity decreases resulted in increased BMI in this CHD group, leading to low exercise tolerance and health complications.

(Where did the study take place?)

Sweden, University Hospital Center, outpatient visits. Three Hospitals in Sidney, Australia. Department of Pediatric Cardiology and Cardiac Surgery.

Bambino Gesù Children’s Hospital


Sample 79 adult patients with CHD One hundred thirty-two adult patients with CHF. 880 patients, 16-18 years old with CHD
Method Experimental research method

Stable patients for the last three months

Four groups based on the diagnosis. The Control group matched gender and age with no CHD, taking aspirin, high blood pressure, and cholesterol medications. Exercises strategies.

Excluded criteria were cognitive impairment.

In experimental research, CHF, stable patients were divided into Home-Heart-Walk, and the control group was randomized and selected to analyze physical and behavioral outcomes. Survey

Patients who had a stress test in 4 months, October 2020- February 2021, and had a similar test a year before were questioned about physical activities before and during the pandemic. Test tolerance compared to the previous one.

Key Findings of the Study The level of exercise self-efficacy related to age, muscle strength, and medication management in patients with CHD The study had no visible physical impact on CHF patients, and the behavioral aspects improved. The COVID-19 pandemic impacted this group’s physical activity and tolerance.
Recommendations of the Researcher Implementing physical activities and multidisciplinary therapy improves the quality of life and helps to reduce hospital visits in patients with CHD. The HHW test can promote self-care management behaviors and efficacy for CHF patients. During the pandemic, physical activities at home could be effective and should be used for future adversities.
Criteria Article 4 Article 5 Article 6
APA-Formatted Article Citation with Permalink  



mme Petersen, A. K., Oestergaard, L. G., van Tulder, M., & Laustsen, S. (2020). A comparison of high versus low dose of exercise training in exercise-based cardiac rehabilitation: a randomized controlled trial with 12-months follow-up. Clinical Rehabilitation, 34(1), 69–81. https://doi.org/







Fnnkv Sandberg, C., Rinnström, D., Engström, G., Dellborg, M., Thilén, U., Sörensson, P., Nielsen, N.-E., Christersson, C., & Johansson, B. (2019). Factors associated with health-related quality of life among adults with tetralogy of Fallot. Open Heart, 6(1), e000932. https://doi.org/







Bert Westerhuis, PhD, Cynthis Bonhof, Johan Denollet, PhD. Jos Withershoven, MD, Ph.D. Nina Kupper, Ph.D., (2020). A comparison of high versus low dose of exercise training in exercise-based cardiac rehabilitation: a randomized controlled trial with 12-months follow-up. Clinical Rehabilitation, 34(1), 69–81.




How Does the Article Relate to the PICOT Question?  

Patients in cardiac rehab performing exercise routines, high and low doses. The benefits of each modality to patients’ outcomes include improving aerobic and muscle strength over 12 months.

For patients with Tetralogy of Fallot, health improvement is based on managing a good quality of life in relation to a healthy lifestyle and follow-up with health care providers. Implementing exercise and a good quality of life could help these patients not have events for a long time. Patients with CHF experience dyspnea, which

Influences on exercise activities and quality

of lifestyle in these patients, the lack of physical

activities due to the symptoms, increase hospital

admissions. Medication management, a healthy diet, and exercise can decrease the compilations

to CHF patients from Dyspnea.  

Quantitative, Qualitative (How do you know?) Quantitative, 164 cardiac patients.

Qualitative, 1-hour exercise either three times a week for 12 weeks (high dose) or two times a week for eight weeks (low dose)


Quantitative, 288 patients.

Qualitative, Tetralogy of Fallot, 18 and older.


Quantitative, 464 Heart Failure patients.

Qualitative, depression and anxiety, psychological




Purpose Statement Determine the impact of high and low doses of exercise with the same intensity for the two cardiac patients’ groups. The implications of a good health-related quality of life prevent morbidities in these patients. Dyspnea related to CHF patients and the ability

to be physically active, psychological aspects.

Research Question Does the length and dose of exercise improve cardiac patients’ aerobic and muscle endurance in a cardiac-based exercise rehab? Does the quality of life impact Tetralogy of Fallot health outcomes in adult patients? How do psychological aspects affect patients

with CHF?



Outcome There was a difference between the two groups, with a better outcome in patients with a high dose of exercise.


The health outcomes based on the quality of life and exercise pattern positively impact these patients and reduce health complications or disease events. Psychological factors like anxiety, depression, and being older and overweight increase dyspnea symptoms, limiting these patients’ physical activities.

(Where did the study take place?)


Aarthus University Hospital. Aarthus, Denmark.


New York Heart Association.


Tweesteden Teaching Hospital Clinic.
Sample 164 Cardiac Patients, randomized. Two hundred eighty-eight patients, randomized regression. Four hundred sixty-four heart failure patients, randomized.
Method Two groups 1 hour of exercise, one group 3 times a week for 12 weeks with a high dose of exercises and the other two times a week for eight weeks with a low dose of exercises with the same type of training and intensity.  Physical activities, medications, cardiac output, symptoms association were observed in a logistic regression method about quality of life. Psychological factors, demographics, and physical

activities related to dyspnea in patients with


Key Findings of the Study The high dose of exercise intensity slightly differed in aerobic and muscle outcomes. The asymptomatic results were related to a good quality of life with exercise routines and medication management.  Anxiety, depression, obesity are factors that influence

dyspnea in CHF patients.

Recommendations of the Researcher Patients in the study had different diagnoses and comorbidities. The study is highly generalized.  Encourage a healthy lifestyle with regular physical activity to increase the quality of life in these patients The psychological aspects need to be

addressed with CHF with dyspnea


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