My PICOT question is about postmenopausal women who engage in high to moderate aerobic exercise for at least 45 minutes per week and low-calorie diet

My PICOT question is about postmenopausal women who engage in high to moderate aerobic exercise for at least 45 minutes per week and low-calorie diet, does personal digital assistant monitor group diet and exercise program compared to those who do not participate in a program improve BMI scores over a 3-month period?
Stakeholders involved in this CSP are the MD/NP, obese postmenopausal women, and nutritionist. The role of the obese postmenopausal women in this project is to keep track of the physical activities and food intake using the personal digital assistant. They are also responsible for noting the number of calories burnt depending on the length of time for the exercise and they choose different types of physical activities based on the intensity. The MD/NP role in this project is to provide recommendations, prepare the weight loss chart and suggest the practice that needs to be changed. The MD/NP will educate participants on the kinds/ duration of exercise that will bring a positive outcome. In addition, MD/NP prepares the weight loss chart for weekly monitoring of the participant progress and calculates the reduction needed in the number of calories in order to maintain ideal Body mass index (BMI). The nutritionist is involved in reviewing Body metabolic rate (BMR), BMI, current weight, ideal weight, calories to consume, and plan for weight loss as suggested by the MD/NP. The nutritionist also recommends a food plan that is healthy to maintain ideal BMI and if needed, online mobile chatting can be initiated with the participant.
Educational Theory and Conceptual Framework
The prevalence of obesity among postmenopausal women can be affected by different factors, but the most common factor is the disproportion between calorie intake and calorie expenditure. Considering that the increased prevalence rate of obesity is affected by several factors, the socio-ecological framework is chosen for this project. The socio-ecological framework is a model that is focused on the different causes and effects as well as providing a means for monitoring the numerous effects (Sallis & Glanz, 2009). It also considers the relationship with the social factors that contribute to obesity (Sallis & Glanz, 2009).
The social-ecological model acknowledged that the addition of both individual level and environmental level approach is necessary to achieve a feasible improvement in health behaviors. Steps towards behavioral change are more likely to be outstanding when the numerous levels of impacts are checked at the same time. Applying this to the project explains that in order to fight obesity by increasing exercise, strategies need to center not only on the choices of behavior each person but also on factors that impact those choices. The social-ecological model helps to determine ways to improve participation in physical activity by noticing the multiple factors that affect an individual’s behavior in fighting obesity
The motivational theory is another theory that is vital to this project. Behavior in a human being is hard to adjust, mostly in a surrounding that does not encourage new development. Health behaviors, including participating in physical activities are thought to be improved when environments, healthy choices, and individuals are motivated and educated to make those choices. Several studies indicated that physical activities are increased with motivation thereby decreasing weight as well as maintenance of ideal weight. (West et al., 2011). According to West et al (2011), recent educational/ theoretical based motivation focused program is important to weight loss and maintenance. In this project, participants will be encouraged to post their success or concern on the program social mobile app in order to motivate others. This motivational theory can also be applied by phone call or email follow up as well as some motivational tips every week in order to increase adherence to the program. According to Teixeira et al (2012), professionals treating or counseling obese patients agree that motivation is paramount to weight loss success. The absence of motivation leads to poor adherence to a weight control program (Teixeira et al., 2012).
Educational intervention
The prevalence rate of obesity has been on the rise for the past decade and it is becoming a concern for public health. Also, there is an increase in obesity-associated diseases such as a cardiovascular disease, some kinds of cancer, hypertension, diabetes, sleep apnea, osteoarthritis, and mental health problems (Foster-Schubert et al., 2012). According to the CDC report, 66.3% of adults in America are either overweight or obese and the identified cause is mainly lack of exercise (Conti, Lippi ; Gensini, 2014). It is also indicated that about 40% of adults in America do not exercise and less than one – third of adults participate in the suggested volume of physical activity (Conti, Lippi ; Gensini 2014). In America, there is a higher incident rate of obesity among postmenopausal women older than 50 years when measured with premenopausal women; about 47.6% of postmenopausal women are overweight, and above 25% account for the number that is obese (Su Yon et al., n.d).
The chances for weight gain is high among postmenopausal women and the best intervention for weight loss is lifestyle modification. In addition to exposure to physical chronic diseases associated with obesity, postmenopausal women may also be affected psychologically, and this may have a grave impact on health-associated quality of life (Foster-Schubert et al., 2012). The basis of beneficial interventions for treatment or prevention of obesity-associated diseases is weight loss through the change in lifestyle such as diet modification and exercise monitored with the personal digital assistant (PDA) as well as behavior change to reinforce these changes. MD/NP, postmenopausal women and nutritionist participation in this project will facilitate a positive outcome thereby motivating others to join the program. This project is worth implementing considering the effect of obesity on health and knowing the impact of lifestyle modification with monitoring/ motivation.
Implementation plan
The project is proposed to be monitored for twelve weeks. This duration was chosen because of a study review by Merrill ; Aldana (2009) that indicated that the primary difference in exercise can happen at six weeks versus six to eighteen months but require encouragement and sustenance for improved longer duration outcomes. I intend to give the questionnaire to postmenopausal women in a weight loss clinic, where they already use sensors and social network. The weight for all participants are measured and BMI calculated at the beginning, weekly and end of the program duration in order to monitor progress. Collected data will be registered to data mining and sentiment analysis algorithms (Harous et al., 2018). Data collection is done via social network and sensors. In actuality, the program will work together with a strong nonprofit organization in the community, there will be support from the community such as assistance with any needed fund and volunteers. Local Park is chosen for the program because it decreases the need for numerous authorization and approvals from different advisory boards. The park is equipped with benches and tables that would be used for the teaching sessions. In the chosen park, there should be access to basketball, volleyball courts; baseball and soccer fields which eliminate the need for equipment payment. The group will meet weekly where teaching sessions are done. Within the week, the mobile app is used for communication and feedback. My clinical scholarly project will help to decrease obesity-associated diseases, hospitalization and improve self-esteem among postmenopausal women.