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Outcome: Research proposal (80% weighting)
Where to begin: identify a research/project question from their area of practice or interests related to Global Health
Why does it matter: it will go on to form your dissertation
Word count: no longer than 3000 words (excluding Ref and appendices)
Cover sheet and table of contents-100 words
Abstract -400 words
Introduction and Background-500 words
Literature Review-500 words
Research Questions, Aims and Objectives-400 words
Methodology (Rationale for the chosen review approach, search strategy, inclusion and exclusion criteria, critical appraisal tool)- 700 words
Strengths and weaknesses/limitations of a narrative review-400
Diabetes is a global health issue since it affects middle to older aged population of the world. According to the already available evidence pieces, it can be said that 150 minutes or more time consumed per week for physical exercises can help in managing diabetes in both middle aged as well as elderly people. Non pharmacological interventions for the management of diabetes have been observed to be beneficial due to its lack of side effects.
Therefore, it is more effective for ensuring quality of wellbeing as compared to its pharmacological counterparts. Aerobic exercising on regular basis can improve insulin functioning in the body. Therefore, it leads to lowering of blood sugar and diet control helps in achieving diet control targets based on long term basis.
Furthermore, previous research studies have stated that a combination of both exercise and diet control helps in reducing blood sugar and lead to better management of diabetes. The proposed narrative review will find out the difference in effectiveness of physical exercise compared to diet control, in managing diabetes in middle aged and elderly T2DM patients.
The selected methodology for the proposed research study will be associated with secondary design. Narrative review design will be specifically followed for the proposed research. Keyword based research strategy will be followed for the data collection process.
Four specific and authentic databases will be selected for the data collection in order to perform narrative review. There was no requirement of ethical approval since the proposed research was based on narrative review design.
The main strength of the proposed narrative review will be flexibility and high evidence base level of the findings. On the other hand, the main weakness of the proposed narrative review will be the absence of risk of bias analysis for the collected pieces of evidence, needed for the review.
The limitation needs to be controlled in order to improve the quality of the proposed review findings. Another limitation of the proposed narrative review will be that the outcomes will be based on previously available evidences and no novel findings based on live data can be obtained.
On a summarising note, the proposed review will be conducted by using narrative design. The review will help in comparing exercise and diet, in controlling the progression of diabetes.
Moreover, the study is expected to address the aim and objectives, successfully, depending on the number of available evidences based on the inclusion and exclusion criteria.
Type 2 diabetes is a categorical part that comes under diabetes mellitus. The disease is regarded as a global health issue since 537 million adults are currently affected by the chronic disease.
This occurs when the blood sugar level as a result of consumption of food gets increased in the blood of an individual (NHS, 2021). The pancreas is one of the organs in the human body that is responsible for producing the hormone that is insulin which balances the sugar level into the blood.
However, in the case of type-2 diabetes, the body does not properly use insulin or is unable to make insulin resulting in type-2 diabetes (Toi et al., 2020). Physical inactivity and improper diet are some of them that give rise to high blood pressure and increase the chance of developing diabetes.
On a global scale, 29.2% of the older people were affected by diabetes in 2021 (Rajput et al., 2022). The numbers have increased significantly in 2022 and 2023. The findings of Public Health England, (2016), stated that 72% of adults from age 40 to 45 were most likely to meet physical activity guidelines while this percentage decreases as the age increases.
Since physical activity and diet control are the non pharmacological interventions, they were chosen as the best intervention for 40-60 years people, used for diabetes control.
The significant rise in the prevalence of diabetes among demographic groups aged 40-60 years in the UK has reached an alarming level. As per the “Health Survey for England 2011-2019”, it has been identified that the prevalence of total diagnosed diabetes among men was 9% while undiagnosed was 6% in 2019 belonging from age 45 to 64 years (NHS, 2021).
On the other hand, in the case of females the diagnosed diabetes was 7% while the undiagnosed diabetes was 4% among the demographic group aged 45 to 64 years (NHS, 2013).
The General practitioner keeps physical activity as well as dietary intake as one of the risk factors of occurring type-2 diabetes. The findings of the NHS also reveal that remaining physically inactive increases the chances of developing type-2 diabetes.
As per the data of 2015-16 published by the government of the UK, only 41% of adults aged 40-60 years walk less than 1 minute monthly (Public Health England, 2016).
Toi et al., (2020) stated that the combinatorial effect between physical activity and diet control is unknown among most people living in the UK, especially among those who lack diabetes awareness or education.
On the other hand, other journals have focused on highlighting a single parameter either dietary control or physical activity, and its impact on type-2 diabetes among demographic groups aged 40 to 60 years. Therefore, a gap exists that will be filled in this research study.
Research gap primarily exists in understanding the relationship between physical exercise and diet control in diabetes management and prevention. This is because of the fact that most of the previous research studies have either analysed the effect of exercise or diet control on diabetes.
None of the previous research studies, focused on the relationship between the two interventions or the mutual effect of both the interventions in controlling diabetes.
Thus, the current topic of the research was focused on, in order to understand the mechanistic relationship between two non pharmacological interventions in controlling diabetes among 40-60 years old people.
The aim of this research is to analyse the relationship between exercise and diet control in managing diabetes among the middle aged (40 years) and elderly people (60 years) in UK. This specific aim will be fulfilled by completing a series of four connected objectives. The objectives of the proposed narrative review have been stated below.
The research objectives have been developed to address the aim of the proposed research. The objectives of the proposed research study will be as follows –
• To analyse the effect of exercise on diabetes control in 40-60 years people in the UK
• To analyse the effect of diet on diabetes control in 40-60 years people in the UK.
• To analyze the connection between exercise and diet control in 40-60 years people in the UK.
• To recommend on whether to use exercise and diet control together to control diabetes in 40-60 years old people in UK, or not.
The research question for this narrative review will be developed using the PICO framework.
● P- UK population belonging to the age of 40-60 years with type-2 diabetes.
● I- Physical activity.
● C- Diet control
● O- Measuring glycemic index, blood glucose level control, diabetes control .
Therefore, the research questions associated with the research study will be as follows-
“What is the relationship between physical exercise and diet control in diabetes control among 40-60 years old people in the UK?”
The PICO format has been used to represent the research questions since two interventions, one outcome and a population group has already been mentioned in the research topic.
Therefore, depending on all the above stated criteria, PICO framework was thought to be justified for framing the research question. PICO framework has also been used to develop research questions in other review based research papers also (Toi et al. 2020).
Thus, depending on the above stated evidence, it can again be stated that PICO framework is justified for the framing of a research question, concerning the proposed narrative review.
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As per the findings of Diabetes UK (2023), almost 2.4 million people in England were at a high risk of developing type-2 diabetes in 2021-22. However, among them, nearly 850,000 people remained undiagnosed (Diabetes, 2023).
A study conducted by Kriska et al. (2021) found that adults at the age of 40-60 years often have a level of balance between work and family responsibilities. The increasing workload, competition, as well as issues in maintaining work-life balance are affecting their physical activity and imbalances in their dietary intake.
The busy lifestyle as well as challenges due to sedentary occupation results in various health issues. Type-2 diabetes is the most common among them (Kriska et al., 2021). As per the statistics revealed by the government of the UK, only 44.9% of individuals belonging to the age group of 40-60 years walk less than 10 minutes at a brisk pace. The statistics remained lower among women which is 37.9% of the same age group (NHS, 2021).
Furthermore, as accompanied by Goldenberg et al. (2021), the lack of the right choices in the case of dietary intake and physical activity is also one of the issues that affect the glycemic index among people at this age (Goldenberg et al., 2021).
Moreover, people at this age are at higher risk of acquiring hypertension, heart disease, and much more which are also some of the risk factors of occuring type-2 diabetes among people living in the UK.
As opined by Rajput et al. (2022), both physical activity and dietary intake are known to manage the glycemic index of an individual. As per the data from the NHS, 150 minutes of moderate physical activity including strengthening exercises can improve insulin sensitivity, resulting in better utilisation of glucose (Rajput et al., 2022).
This helps in managing blood sugar levels and reduces insulin resistance. As highlighted by Ahmed et al. (2023), a balanced diet that includes one to two vegetables, controlled carbohydrates, as well as fruits rich in vitamins and minerals can help influence blood sugar levels. When shared with physical movement, both perspectivessettle blood sugar levels, driving move forward in glycemic list in grown-ups (Ahmed et al., 2023).
Agreeing with Wang et al. (2020), being overweight is additionally one of the hazardvariables that increments the hazard of type-2 diabetes among grown-ups. Expanding weight comes about from dishonorable dietary admissions or physical inertia.It has been apparent that both physical action and dietary administrationoffer assistance in overseeing weight (Wang et al., 2020).
Physical movementincrementsvitalityconsumption and makes a difference in burning an overabundance of calories whereas dietary control makes a difference in expending calories in overabundance. So also, the amalgamation of both physical movement and dietary admissions can have an effect on affrontaffectability, long-term way of life adherence, mental well-being, and much more.
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Concurring to Vilafranca Cartagena et al. (2021), monetaryimperatives are one of the perspectives that can limit a person from receiving physical movement and sound dietary hones. Incongruities are common among grown-upswithin the UK whether it can be in getting towork outchoices or securingreasonable dietary choices.
Aberrations in getting toexercise centeroffices, sports gear, and nutritious nourishment can causeissues for grown-ups in overseeing type-2 diabetes (Vilafranca Cartagena et al., 2021). Comparing against this, Brennan et al. (2021) expressed that the need for information is one of the obstructions that can limit a person from overseeing type-2 diabetes (Brennan et al., 2021).
The need for informationconcerning the significance of physical movement, parcel control, adjustedcount calories, as well as making solid choices is another calculate that can exasperate type-2 diabetes among grown-upswithin the UK.
The chosen research topic is – “The relationship between physical exercise and diet control in managing T2 diabetes among 40 and 60 years old people”. This research topic is primarily based on the analysis of diabetes management techniques and its effectiveness in middle aged and elderly people.
Therefore, it can be stated that the study design will be secondary for the proposed research. Since the topic has two variables of interest – diet control and physical exercise, it can be said that the proposal will take the form of a quantitative study.
Therefore, a narrative review design can be stated to be the best secondary research design, chosen for the proposed research. Also, there are many case control research, cross-sectional research and quantitative study designs available for the chosen topic, which are mainly based on primary designs.
Thus, it the proposed research study will take the approach of a narrative review. Narrative reviews have several strengths, which increases the potency of that in being the best research design for the proposed research (Jenkins and Jenks 2017).
The proposed research deign will be best for flexible and practicality of both the interventions, in the management of type 2 diabetes. In other words, it can be said that narrative reviews are specifically helpful for specifically addressing the study objectives in the fastest way. Therefore, depending on all the above evidences, it can be stated that the chosen review approach is best for the proposed research.
Keyword based search strategy are utilized in researching for relevant data considered for the study. This search strategy has been mostly used in other secondary research studies also (Kimet al. 2021).
The selection process mainly will include the selection of specific keywords, extracted from the research topic. Furthermore, these keywords will be placed in the search boxes of NHS UK, PubMed, CINAHL and Cochrane databases, in order to get the required number of papers, to perform narrative review.
Furthermore, it was observed that BOOLEAN operators are used to modify the search results, and make the search more specific (Wahlet al. 2018). The AND operator will be used to separate different keywords and the OR operator will be used to separate the synonyms of the keywords. The keyword table has been shown below in the form or PICO framework.
Table 1 – Search strategy table
| PICO framework | Keywords | Synonyms | BOOLEAN operator |
| Population | People, 40 years, 60 years, Patients. | Diabetic patients, middle aged, elderly patients | OR |
| Intervention | Physical exercise | Exercise, physical activity, gym, walking, running, resistance training, strength training | OR |
| Comparison | Diet control | Balanced diet, low sugar diet, low fat diet, protein diet, carb free diet | OR |
| Outcome | Diabetes management | Blood glucose reduction, hyperglycemia management, diabetes reduction | OR |
| AND | AND | ||
The inclusion and exclusion criteria for the proposed narrative review have been shown by using the PICO framework –
Table 2 – Inclusion and Exclusion criteria
| PICO Framework/Selection criteria | Inclusion criteria | Exclusion criteria |
| Population | Diabetic patients belonging to 40-60 years age group. | Other patients of other age groups |
| Intervention | Physical exercise | Other interventions such medicines and drug usages |
| Comparison | Diet control | Other non pharmacological diabetes control interventions |
| Outcome | Diabetes management | Management of other diseases |
Other inclusion criteria will be –
• Research papers will be published in English
• Research papers will be published between 2010-2023.
Other exclusion criteria will be –
• Research papers will not be published in English
• Research will be published before 2010.
Quality appraisal is one of the most significant sections of a secondary research paper. This is because of the fact that quality of the papers selected for the review, finally affects the quality of the research findings.
In other words, it can be said that for the proposed review, most of the papers will be case control papers, observational research papers and intervention studies.
Therefore, the quality appraisal too will be based on the above stated study designs only. Critical appraisal skills programme or the CASP tool will be used for assessing the quality of the papers that will be chosen for the proposed narrative review.
Narrative reviews are associated with both strength and weaknesses. However, it has been observed that these strengths and weaknesses varies, based on alterations in research topic.
Therefore, it can be said that the proposed research study will also have certain strengths and weaknesses. Addressing these strengths and weaknesses is essential in order to increase the quality of the study findings (Thielenet al. 2023). The following section has talked of the strength of narrative review first, and then its weaknesses.
Narrative review will provide more flexibility and practicality to the proposed research findings (Thielenet al. 2023). Furthermore, the use of a keyword based research strategy will be helpful in producing more specific findings from the search process. The selection of authentic database will help in finding the relevant pieces of evidence for the proposed research.
Another strength of this research study will be based on the addressing of a research topic, associated with previously existing research gap in the knowledge base associated with the research topic.
Furthermore, another strength of this research study is that it has no specific ethical approval requirement or any financial commitments to be done for performing the proposed narrative review.
These strengths will in turn make it ideal to perform a narrative review research by a single researcher. The proposed narrative review will be comprised of the above stated strengths.
However, it has been observed that there are several weaknesses of the narrative review. These weaknesses will include the lack of statistical analysis, in addressing a quantitative design based topic.
Furthermore, it has been observed that the inclusion of all primary research studies in the proposed review will be exposed to statistical bias (Yanget al. 2014). Moreover, another limitation will be there for the proposed research study. In other words, it can be said that this limitation was there due to a long period of data collection, selected for the proposed research.
The selection of this long period for data collection increases the risk of introducing obsolete data in the findings of the proposed research. The proposed research study be associated with the above stated research limitations.
However, not keeping aside the limitations, it can be said that the proposed review study will provide valuable exploration of the topic. The existing knowledge gap will also be further filled by the proposed research study.
Therefore, it can be said that after the conduction of the proposed review, the best out of exercise and diet control can be chosen as the interventions for diabetes control.
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Brennan, M.C., Brown, J.A., Ntoumanis, N. and Leslie, G.D., 2021. Barriers and facilitators of physical activity participation in adults living with type 1 diabetes: a systematic scoping review. Applied Physiology, Nutrition, and Metabolism, 46(2), pp.95-107.
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Jenkins, D.W. and Jenks, A., 2017. Exercise and diabetes: a narrative review. The Journal of Foot and Ankle Surgery, 56(5), pp.968-974.
Kim, S.W., Jung, W.S., Chung, S. and Park, H.Y., 2021. Exercise intervention under hypoxic condition as a new therapeutic paradigm for type 2 diabetes mellitus: A narrative review. World Journal of Diabetes, 12(4), p.331.
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Rajput, S.A., Ashraff, S. and Siddiqui, M., 2022. Diet and management of type II diabetes mellitus in the United Kingdom: a narrative review. Diabetology, 3(1), pp.72-78.
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