Rajiv Ghandi University of Health Science

Rajiv Ghandi University of Health Science

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

DISSERTATION PROPOSAL.

“A STUDY TO EVALUATE THE EFFECTIVENESS OF VIDEO ASSISTED TEACHINGPROGRAM REGARDING THE INFLUENCE OF AEROBIC EXERCISES ON POSTMENOPAUSAL SYMPTOMS AMONG POST MENOPAUSAL WOMEN RESIDING AT SELECTED COMMUNITY AREAS IN BANGALORE”

SUBMITTED BY,

MS. NIMMY FRANCIS

1ST YEAR M.Sc. NURSING

ROYAL COLLEGE OF NURSING

UTTARAHALLI

BANGALORE- 560061

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA SYNOSPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / Name of the Candidate and
Address / Ms.NIMMY FRANCIS
1ST YEAR M.Sc. NURSING
ROYAL COLLEGE OF NURSING
7TH MAIN, 1ST BLOCK, UTTARAHALLI,
BANGALORE-560061
2. / Name of the Institution / ROYAL COLLEGE OF NURSING
3. / Course of study / 1 Year M.Sc. Nursing,
Obstetrical and gynecological nursing.
4. / Date of admission to course / 1/06/2012
5. / Title of the Topic: “A study to evaluate the effectiveness of video assistedteaching program regardingthe influence of aerobic exerciseson postmenopausal symptoms among post menopausal women residing at selected community areas in Bangalore”.
6. / Brief resume of the intended work:
6.1 Need for the study
6.2 Review of literature
6.3 Objectives of the study
6.4 Operational definitions
6.5 Hypothesis of the study
6.6 Assumptions
6.7 Delimitations of the study
6.8 Pilot study
6.9 Variables / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7. / Materials and methods
7.1 Source of data- Data will be collected from women residing at selected community area, Bangalore.
7.2 Method of collection of data- Structured Knowledge Questionnaire.
7.3 Does the study require any interventions or investigation to the patients or other
Human being or animals? Yes
7.4 Has ethical clearance been obtained from your institution? Yes,ethical committee’s report is here with enclosed
List of references / Enclosed

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / Ms. NIMMY FRANCIS
1ST YEAR M. Sc NURSING,
ROYAL COLLEGE OF NURSING,
7th MAIN ROAD,
UTTARAHALLI, BANGALORE: 560061.
2s / Name of the Institution / Royal College of Nursing.
3 / Course of Study and Subject / 1st Year M.Sc Nursing,
Obstetrical and gynecological nursing.
4 / Date of Admission to Course / 1/06/2012
5 / Title of the Topic
“A study to evaluate the effectiveness of video assisted teaching program regarding the influence of aerobic exerciseson postmenopausal symptomsamong post menopausal women residing at selected community areas in Bangalore”.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Exercise is a medicine for creating change in a person’s physical, emotional, and mental states”

 -Carol Welch-

The health status of women directly reflects the health status of the nation.The concept of women’s health today has become a major concern among the developing countries because of deteriorating quality of life.Though India has made considerable progress in socio economic development in recent decades such improvement in life expectancy,infant mortality and literacy demonstrate it lagged behind in the improvement of women’s health.1

The transition from reproductive to non-reproductive women is the result of a major reduction in female hormonal production by the ovaries.This transition is normally not sudden or abrupt tend to occur over a period of years and is a natural consequence of ageing which is termed as menopause.So menopause is the permanent cessation of the primary function of the human ovaries.1

After reaching menopause,a woman is vulnerable to many long term health problems due to estrogen loss.Menopause effect women’s health in many ways.Post menopausal women have an increased risk of number of health conditions especially osteoporosis and cardio vascular disease. This increase in the production of estrogen leads to the postmenopausal symptoms of hot flashes, insomnia, night sweat, mood swings as well as osteoporosis and vaginal atrophy.2

Exercise is a most beneficial activity for women in their menopausal years.In fifteen years experience working with thousands of women in their menopausal years,Susan Lark,found exercises helps “relieve and prevent many symptoms of menopause such as osteoporosis,hot flashes,night sweats,thinning and irritation of vagina and urinary tract,depression,insomnia and cardio vascular diseases.2

Aerobicsis a form ofphysical exercisethat combines rhythmicaerobic exercisewithstretchingandstrength trainingroutines with the goal of improving all elements of fitness (flexibility,muscularstrength, andcardio-vascularfitness). It is usually performed to music and may be practiced in a group setting led by aninstructor(fitness professional), although it can be done solo and without musical accompaniment. With the goal of preventing illness and promotingphysical fitness, practitioners perform various routines comprising a number of different dance-like exercises. Formal aerobics classes are divided into different levels of intensity and complexity.2

Aerobic exercise training is strongly recommended in post menopausal women to reduce all type of menopausal symptoms and to improve body composition and overall health. Postmenopausal women who exercise regularly are about half are likely to develop diabetes as their more sedentary counterparts.Even more cases of diabetes might be prevented if overweight women tookoff pounds as a result of increased activity.And postmenopausal women who regularly engaged in any physical activity were 31% less likely to develop diabetes during the study period than women who did not exercise regularly.3

Aerobic exercise facilitates sleep by producing a significant rise in body temperature, followed by a compensatory drop a few hours later. The drop in body temperature, which persists for two to four hours after exercise, makes it easier to fall asleep and stay asleep. An extra benefit of quality sleep: improved mood.3

6.1 NEED FOR THE STUDY

“Those who think they have not time for bodily exercise will sooner or later have to find time for illness”

Menopause is a universal occurrence in every woman as they enter their fifth decade of life.Among them majority of women experiences varying degree of adverse symptoms such as vasomotor instability,hot flushes,headache,night sweat,sleeplessness and loss of hair etc.They may also experiences with certain psychological problems like anxiety,depression and anger,fear loss of memory and lack of concentration.It accounts 55% of women suffer from insomnia and 30% experiences forgetfulness during menopause.4

An estimated 43 million U.S post menopausal women are hypertensive.The sixth Report of the “joint National committee on prevention,detection,evaluation and treatment of High Blood pressure”encourages regular exercise for hypertensive menopausal women.Especially aerobic exercise programs including running,jogging,and weight lifting have demonstrated significant Blood Pressure lowering effects in hypertensive post menopausal women.4

Osteoporosis is a significant health problem in worldwide.Over 25 million people in U.S, 80% of menopausal women are facing this problem.Bones actually weaken with increasing age after 40 and women lose bone mass more rapidly after menopause.Regular weight bearing aerobic exercises like walking can help prevent osteoporosis.The full benefit of walking come from regular schedule of aerobic exercises daily.Aerobic exercises like weight training and lifting weight enhance and maintain bone density and strengthen bones over entire body.4

Heart disease in women rises sharply after menopause because estrogen deficiency includes lipids and vascular changes putting healthy blood vessels at rest.Many adverse effects of ageing and menopause on lipids are reversed by aerobic exercises like hiking,swimming or ballroom dancing.Research on exercise and cholesterol in menopausal women found that endurance aerobic exercise by post menopausal women may help prevent adverse lipid and lipoprotein changes which might predispose them to coronary artery disease.5

Post menopausal women experience mood and sleep disturbance related to estrogen deficiency;vasomotor symptoms like hot flashes,night sweat and joint pain can impair sleep and induce chronic sleep deprivation which can cause mood changes.Regular exercise like yoga and jogging can improve cognitive function,enhance mood and promote daytime alertness and nocturnal sleeplessness.Aerobic exercise can increase endorphin levels which are the body’s natural pain relievers.5

Women notice a gain in weight during menopause although their eating habits have not changed.Studies found health promotion sessions with a gynecologist,nutritionist and physical therapist focusing on different type of aerobic exercises can increase the general health of menopausal women.Aerobic exercise like weight lifting, walking etc can increase energy expenditure and increase body mass and are the most effective ways to treat weight gain.5

Women experience urinary frequency and incontinence during menopause and post menopause.Researches have shown that pelvic muscle exercise decrease urine leakage in women with stress and urge urinary incontinence with overactive bladder frequency.Pelvic muscle exercise that increase support to the urethral sphincter and bladder muscle are taught to prevent further symptoms.By such regular exercise, it helps to increase muscle strength significantly and decrease urine loss.6

A small study from Duke University examined the effects of aerobic exercise and strength training in healthy post menopausal women.After three months,the women who exercised not only experienced fitness gain but they also had less severe post menopausal symptoms.And aerobic exercise appeared more beneficial than strength training,particularly for post menopausal symptoms related depression.6

Aerobic exercise prompts the release of mood-lifting hormones and neurotransmitters,when relieve stress and promote a sense of well being.Duke University scientists even found that regular aerobic exercise could be as effective as an antidepressant drugs in reducing symptoms of depression in menopausal women.Some women fear that menopause signals a loss of attractiveness and validity.For women at mid-life,regular exercise has been shown to improve body satisfaction,self confidence and sense of control and decrease anxiety associated with body image.6

6.2 REVIEW OF RELATED LITRATURE

“Review of literature is a summary of research on a topic of interest,often prepared to put a research problem in the context or as the basis for an implementation project”.A literature review helps to play the foundation for the study and can also inspire new research ideas.

A study conducted for understanding of how to use exercise effectively in post menopausal women in prevention of osteoporosis.Fifty post menopausal women participated in this study and were divided into two equal groups.A) Received resistance exercise training,B) received aerobic exercises .The program consisted of three sessions post menopausal women for six months.Results revealed that aerobic exercise training in post menopausal women induces more effective favorable changes in bone mineral status as compared to resistance exercise training.7

A study was conducted to evaluate the effect of aerobic exercise for 12 weeks on the levels of cholesterol low density lipoprotein cholesterol,high density lipoprotein cholesterol and triglycerides among post menopausal women.The participants comprising 62 post menopausal women,aged 50-65yrs,not on hormonal therapy,consuming a regular diet,living in East and South Jakarta,and willing to perform aerobic exercises regularly.The results of this study showed that all four lipid levels differed significantly between the control group and intervention group and recommending aerobic exercises for coronary artery disease risk reduction in post menopausal women.8

A study was conducted to examine the effect of different doses of aerobic exercise training on endothelial function in secondary obese post menopausal women with elevated blood pressure.Obese post menopausal women with elevated blood pressure were randomly assigned to one of four groups; 4,8,12 kilocalories per kilogram of energy expenditure per week or a non-exercise control group for 6 months.The results reveal,aerobic exercise training improves endothelial function in menopausal women with cardiac risk.9

A study was conducted to determine 10 post menopausal women with high normal blood pressure or stage 1 essential hypertension were studied through out a 12 wk lead in period(non exercise) and 12 wks of moderate intensity aerobic exercise.Maximal aerobic capacity assessed by maximal oxygen consumption was unchanged after 12 wks of exercise,but exercise tolerance(treadmill walking time) increased by 10% in blood pressure was observed in every stage but significant reduction in blood pressure during sub maximal exercise occurred.10

A study was conducted to assess whether aerobic exercise affects menopausal symptoms in recently postmenopausal sedentary women.Symptomatic women aged 45-63yrs were randomly assigned to an aerobic training or a control group.The intervention included unsupervised aerobic training for 50 mints four times weekly for 24 weeks,whereas the control group attended health lecture twice a months.Results revealed that sedentary women who did aerobic exercises for six months decreased their typical menopausal symptoms especially,night sweats,mood swings and irritability.11

A study was conducted to investigate the effects of aerobic exercise training on resting heart rate,blood pressure and anthropometric variable of postmenopausal women.Twenty nine postmenopausal women were divided into two groups;intervention and control.Subjects in the intervention group performed 15 weeks aerobic exercise training including walking for 25-45 minutes and subjects in the control group didn’t have any intervention.Results revealed that significant differences were observes for,resting heart rate,body weight,body mass index of postmenopausal women.12

A study was conducted to findout the effects of walking at the aerobic threshold level on vertebral bone loss in post menopausal women.33 post menopausal women were randomized to control or two exercise groups.All women performed a treadmill exercise test was measured by expired gas analysis.They conclude that short term exercise with intensity above the aerobic threshold is safe and effective in preventing post menopausal bone loss.13

A study was conducted to determine changes in adiponectine levels with moderate weight loss,weight loss plus aerobic exercise or weight loss plus resistive exercise in overweight and obese sedentary post menopausal women.A longitudinal,clinical intervention study of 6 month duration results in weight loss,weight loss plus aerobic exercise,or weight loss plus resistive exercise.They studies 40 sedentary over weight and obese post menopausal women.Result says plasma adipose levels do not change with six months moderate weight reduction program on when accomplished by aerobic training in over weight and obese post menopausal women.14

A study was conducted to investigate whether a 24 week program of a exercise was beneficial for enhancing physical fitness and bone mineral density in post menopausal women.43 post menopausal women aged 48-60 years participated in this study.22 subject joined the exercise group and attend the training program and 21 served as control group.In conclusion,the study revealed that the subjects who did the aerobic exercise andtraining program was effective in offsetting decline in bone mineral density in estrogenic post menopausal women than control group.15

A study was conducted concerning the effects of aerobic exercise on vasomotor and other menopausal symptoms is limited but what evidence we do have suggests that aerobic exercise can improve psychological health and quality of life .In addition,several ranks of menopausal aged women have found that aerobic exercise can invoke significant improvements in several common menopausal symptoms like mood,insomnia etc.Whilst both the Royal College of Obstetrical and Gynecologists in the North American Menopause society have recommended that women be advised to consider aerobic exercise as a treatment for vasomotor menopausal symptoms.16

A study was conducted to examines the effects of weight loss by caloric restriction and aerobic exercise plus weight loss on total and regional bone mineral density (BMD) in postmenopausal women not on hormone-replacement therapy underwent 6 mo of WL (n= 15) consisting of dietary counseling one time per week with a caloric deficit (250–350 kcal/day) or aerobic exercise plus weight loss (n= 15) consisting of treadmill exercise three times per week in addition to the weight loss. Weight loss and aerobic exercise plus weight loss both result in losses of total body BMD; however, aerobic exercise plus weight loss appears to prevent the loss in regional BMD seen with weight loss alone in healthy post menopausal women. This suggests that the addition of exercise to weight-loss programs may reduce the risk for bone loss.17

A study was conducted to estimate whether aerobic exercise has an effect on frequency of hot flashes or quality life of postmenopausal women.Symptomatic sedentary women 43-60 years were randomly assigned to aerobic training or control group.The interventions includeaerobic exercise training for 50 minutes four times per week for six months,whereas the control group didn’t have any intervention.In conclusion, the result revealed that aerobic exercise training decreases the frequency of hot flashes and improve quality of life among slightly over weight postmenopausal women.18