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Part 1- Appraisal Paper 1

Discuss about the Nursing for Pain Management.

The report critically appraises two articles-one investigating the impact of 20 week aerobic exercise training on reducing emotional stress in participants and the other article investigating the impact of Kouk Sun Do, a mind-body exercise on reducing stress. The scenario is about Mariana, a single mother with 18 month old daughter who is a health science student of Australian University. Her daughter has severe asthma and Mariana is diabetic and has severe blood disorder. In the absence of family and social support, she suffers intense stress. The evaluation of the two papers will be done on the basis of evidence based practice to identify how researcher compares different literature and identify the gap in the field of study to carry out the investigation (Polit & Beck, 2013). The first critical appraisal paper is a randomized controlled study and another is qualitative pilot study. The purpose of the report is to critically appraise the two papers and determine its strength and weakness to assess which is more relevant to reduce stress and improve mood in case of Mariana.

Author- Von Haaren et al., (2015).

Journal- Journal of psychology of sport and exercise

Ethical considerations- The research was carried out ethically with permissions from University.

Title- The impact of ambulatory assessment and the reduction of emotional stress after participation in 20 week aerobic exercise training.

Abstract- The abstract of the journal article effectively provides a brief summary of the journal of the purpose and method of conducting a research. The aim of the study was to investigate the improvement in emotional stress reactivity after 20 weeks of aerobic exercise. The whole process of investigation has been summarized in a cohesive way by which a person can easily understand the research and it contributes to credibility of the work (Elo et al., 2014).

Purpose- The purpose of carrying out any research is very essential as it clearly reports what is missing in the field of study and what needs to be known further to get better understanding on the topic (Thornton, 2013). The significance of the research became evident when the researcher analyzed existing literature to find that physiological stress reactivity has been studied but very little research has been done on assessing emotional stress response (Lataster et al., 2013).. Existing research on relation between exercise and emotional stress reactivity has many limitations and nothing has been studied regarding its effect on exercise in real life setting. Hence the purpose of investigation became clear (Von Haaren et al., 2015).

Part 2- Appraisal Paper 2

Methods/ Design- There were different scale for assessment of moods, perceived stress and aerobic capacity of participants. A randomized controlled trial was conducted with 61 engineering participants in which the control group received cardiopulmonary exercise test after the end of research while the other group, the stress level was assessed two times during the exam period. The experimental group was given aerobic running training and the outcome of the cardiopulmonary test was assessed running speed and lactate threshold. The method was useful as it used statistical analysis with maximum oxygen consumption to determine the efficacy of intervention.

Discussion- The results showed that there was no difference cardiopulmonary testing parameter between control group and intervention group before the intervention. However, aerobic capacity in the intervention group increased by 8.7% post intervention, while in control group the aerobic capacity increased by 5.6%. Hence the author was successful in proving that 20 week aerobic exercise lowers emotional response to stress in real life. The study was also consistent with the research by Klaperski et al., (2013) which showed more physically active group had lower reactivity to stress response

Limitations- The limitation of the finding is that the study findings cannot be readily accepted as the study was done only on same age group of healthy people. Greater insights to the effect on stress response could be been determined by carrying out the research other group of people. There was also gap in assessment as no physiology triggered assessment tool was utilized and hence highly stressful moments might have been missed.

Conclusion- This research is significant to change the concept of stress response people. The normal trend is that people in stress resort to sub-optimal activities. Hence, exercise has long term health benefits and it reduces stress and depression in life. The positive is possible due to the effects of exercise on mood.

Levels and hierarchy of evidence-The research article come under the hierarchy of unfiltered information as the study was conducted using the randomized controlled trials (NHMRC, 2009). Under JBI level of evidence, it comes under experimental studies (JBI, 2016) and under ‘6S’ hierarchy it comes under the lowest hierarchy of published journals

Applicability- This intervention mentioned in the research can be applied for stress reduction in Mariana if she starts doing regular physical exercise in her life

Strength/weaknesses- The findings of the research is useful in changing the concepts of development of stress and gives new insight into the idea of physical exercise acting as an intervention to reduce stress in life. The weakness of the study is that stress is also caused by environmental and social stressors and the interaction of this factor in stress response has not been considered.

Discussion and Implications for Pain Management

Author- Kim, J., Yang, H., & Schroeppel, S. (2013).

Journal- Health education journal

Ethical consideration- The ethical consideration for research was considered by taking approval for the project from the University’s Institutional Review Board and informed consent were taken from all the participants.

Title- A pilot study exploring the impact of Kouk Sun Do (KSD) on participants with anxiety.

Abstract- KSD sessions were conducted in treatment group over three times per week and stress level and coping with stress for participants were also assessed before and after intervention (Kim et al., 2013). The study findings supported the fact that relaxation method is useful in reducing anxiety symptoms as it was also effective in reducing pain and anxiety in patients with hip arthroplasty (Büyüky?lmaz & A?t?, 2013).

Purpose- Mindfulness training is beneficial in regulation of emotions and treating symptoms of anxiety disorder. Change in neural mechanism is responsible for this improvement in stress response (Hölzel et al., 2013). The researcher focused on investigating the effect Kouk Sun Do, a traditional method of meditative exercise of Korea because the efficacy of this technique has not been evaluated. The criteria for selecting participants were possible because the University students as they are vulnerable to increased anxiety and depression compared to other students.

Methods/ Design- Participants with anxiety symptoms were selected and the treatment groups had to attend KSD sessions while control groups were given the intervention after the treatment group. In the last session, the effects of the session were analyzed by taking feedback from participants (Kim et al., 2013). The data obtained were analyzed using the repeated measure analysis of variance to determine the effect of intervention. The choice of data analysis method is effective, as it is relevant to those experiment were repeated data is taken from participants more than once (Maurissen & Vidmar, 2016).

Discussion- Feedback from participants mostly revealed that KSD helped them relax their mind and body. The positive impact was also seen in daily life routines were participants were successful in handling stressful situations. The study findings were also consistent with previous research on similar topic thus giving support to previous work.

Limitations- The small sample size is the major limitation of the research as it showed that significance statitistical difference could not be obtained,

Conclusion- From the analysis of research study, it became evident that KSD intervention can be beneficial when performed regularly and the research was the evidence for enhancing anxiety symptoms in people with stress. It was also found that coping strategies is interlinked with time and characteristics of people (Kim et al., 2013).

Levels and hierarchy of evidence- The research comes under level II of randomized controlled trial as the research was conducted with control group and intervention group (NHMRC, 2009). In JBI level of evidence it comes under top hierarchy of experimental studies (JBI, 2016). It is unfiltered information and comes under evidence based abstraction journals (Dicenso et al., 2016). 

Applicability- The intervention mentioned in the study had great implication in treating Mariana and reducing her stress and anxiety.

Strengths/weaknesses- The strength of the research is that it was useful in providing an alternative approach to enhance mental health in patients with depression. However, due to small number of participant studied in the research, the study cannot be readily reliable and research with diverse group is required to determine the credibility of intervention.

In the case scenario of Mariana who is a single mother suffering from stress and diabetes, it is essential to find an intervention that helps in improving her response to daily life stressors and reduced her anxiety symptoms. After the analysis of research paper on the effect of aerobic exercise and Kouk Sun Do, it can be said that the second paper on mind-body exercise is the most strongest evidenced related to treating Mariana. This is because Kouk Sun Do combines the element of physical exercise like yoga and meditative exercise too to achieve improvement in stress response. A research study by Bamber & Schneider, (2016) also supports the fact that mindfulness-based meditation is useful to decrease stress. It is similar to the study by Kim et al., (2013) as this research was also carried out with college students suffering from anxiety. Mariana is also a University student and so the stress level experinced by her is similar to the participant in the research study. The reserach by Bamber & Schneider, (2016) is an effective evidence to support the efficacy of mind-based intervnetion because in this case the research analysed many literature investigating the effectiveness of such intervention on reducing stress. Majority of evidence supported the fact that mind-based treatment lead to decrease in anxiety and increase in mindfulness. The strength of the second article is beacuse of the fact that it considered the frequency and duration of Kouk Sun Do to determine is effectiveness in reducing stress.

The first article on effect of aerobic exercise is not a strong evidence that can be applied in case of Mariana. This can be understood from Goldin, et al., (2013) work who compared mind based reduction and aerobic anxiety in addressing social anxiety. This literature is relevant to Mariana’s case because Mariana also experiences societal stress apart from stress experienced in University. The opinion was that mind based exercise improves emotional regulation and the neuro-mechanism is responsible for eliminating negative self-belief. Random patients were subjected to aerobic exercise or mind based programme and it was found that mind-based exercise yielded better results in reducing negative emotions and increasing attention. This change automatically leads to increase in stress response. Hence, regulation of emotion during mind based exercise like Kouk Sun Do is an important psychological factor to reduce stress in patients. Hence, the benefit of Kouk Sun Do is more compared to physical activity in reducing stress and this is the strongest evidence that can applied to treat Mariana and reduce her symptoms.


The report critically appraised two articles on different intervention to reduce stress and emotional response in patients with anxiety syndrome. The report summarized the paper on effect of aerobic exercise and mind-based exercising in reducing stress and depression. Critical evaluation of the research article was done to find the applicability of the findings in case of scenario. The scenario related to Maraina required an approach for stress reduction and mood improvement in Mariana. The applicability of the two papers was analyzed by identifying weakness and strength in the study. Finally, the second paper on Kouk Sun Do as an intervention to reduce stress response was found to be the strongest evidence to applied in case of Mariana. This was supported by other literature which showed that mind-based exercise exhibits neural mechanism to regulate emotions and improve stress symptoms.


Bamber, M. D., & Schneider, J. K. (2016). Mindfulness-based meditation to decrease stress and anxiety in college students: A narrative synthesis of the research. Educational Research Review, 18, 1-32.

Büyüky?lmaz, F., & A?t?, T. (2013). The effect of relaxation techniques and back massage on pain and anxiety in Turkish total hip or knee arthroplasty patients. Pain Management Nursing, 14(3), 143-154.

Dicenso, A., Bayley, L., & Haynes, R.B. (2016). Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. - PubMed - NCBI. Retrieved 21 October 2016, from

Elo, S., Kääriäinen, M., Kanste, O., Pölkki, T., Utriainen, K., & Kyngäs, H. (2014). Qualitative content analysis. Sage Open, 4(1), 2158244014522633.

Goldin, P., Ziv, M., Jazaieri, H., Hahn, K., & Gross, J. J. (2013). MBSR vs aerobic exercise in social anxiety: fMRI of emotion regulation of negative self-beliefs. Social Cognitive and Affective Neuroscience, 8(1), 65-72.

Hölzel, B. K., Hoge, E. A., Greve, D. N., Gard, T., Creswell, J. D., Brown, K. W., ... & Lazar, S. W. (2013). Neural mechanisms of symptom improvements in generalized anxiety disorder following mindfulness training. NeuroImage: Clinical, 2, 448-458.

Kim, J., Yang, H., & Schroeppel, S. (2013). A pilot study examining the effects of kouk sun do on university students with anxiety symptoms: The effects of kouk sun do on mental health. Stress and Health, 29(2), 99-107. doi:10.1002/smi.2431

Klaperski, S., von Dawans, B., Heinrichs, M., & Fuchs, R. (2013). Does the level of physical exercise affect physiological and psychological responses to psychosocial stress in women?Psychology of Sport and Exercise, 14(2), 266-274. doi:10.1016/j.psychsport.2012.11.003

Lataster, T., Valmaggia, L., Lardinois, M., Van Os, J., & Myin-Germeys, I. (2013). Increased stress reactivity: a mechanism specifically associated with the positive symptoms of psychotic disorder. Psychological medicine,43(07), 1389-1400.

Maurissen, J. P., & Vidmar, T. J. (2016). Repeated-Measure Analyses: Which One? A Survey of Statistical Models and Recommendations for Reporting. Neurotoxicology and Teratology.

National Health and Medical Research Council [NHMRC]. (2009). NHMRC additional levels of evidence and grades for recommendation for developers of guidelines.

Polit, D. F., & Beck, C. T. (2013). Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams & Wilkins.

The JBI Approach | JBI. (2016). Retrieved 21 October 2016, from

Thornton, H. (2013). We need to ask “what is the purpose of research?”.

von Haaren, B., Haertel, S., Stumpp, J., Hey, S., & Ebner-Priemer, U. (2015). Reduced emotional stress reactivity to a real-life academic examination stressor in students participating in a 20-week aerobic exercise training: A randomised controlled trial using ambulatory assessment. Psychology of Sport and Exercise, 20, 67-75. doi:10.1016/j.psychsport.2015.04.004

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