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SPECIAL FEATURES: METHODS

Predictive Factors of theNursing Diagnosis Sedentary Lifestyle

in People with High Blood Pressure NirlaGomes Guedes, MarcosVen| ¤ cios de Oliveira Lopes,Thelma Leite de Araujo, Rafaella Pessoa Moreira, and Larissa Castelo Guedes Martins

ABSTRACT Objectives: To verify the reproducibility of defining the characteristics and related factorsin order to identify a sedentary lifestyle in patients with high blood pressure. Design and Sample: A cross-sectional study. 310 patients diagnosed with high blood pressure. Measures: Socio-demographics and variables related to defining the characteristics and related factors of a sedentary lifestyle. The coefficient Kappa was utilized to analyze the reproducibility. The sensitivity, specificity, and predictive value of thedefining characteristics were also analyzed. Logistic regression was applied in the analysis of possible

predictors. Results: The defining characteristic with the greatest sensitivity was demonstrates physical deconditioning (98.92%). The characteristics chooses a daily routine lacking physical exercise and verbalizes

preference for activities low in physical activity presented higher values of specificity (99.21% and 95.97%,respectively). Conclusions: The following indicators were identified as powerful predictors (85.2%) for theidentification of a sedentary lifestyle: demonstrates physical deconditioning, verbalizes preference for activitieslow in physical activity, and lack of training for accomplishment of physical exercise.

Key words: blood pressure, cardiovascular diseases, lifestyle, measurement, statistics.

The term ‘‘clinical indicator’’ has been used as a

synonym of defining characteristics, clinical evidence,and signs and symptoms (Chang et al., 1998). Identi-

fying clinical indicators with a good predictive value

for a specific nursing diagnosis can contribute to

increasing diagnostic accuracy and to improving th

reliability of the diagnostic inference process (Parke& Lunney, 1998).

Defining characteristics are understood as a group

of signs and symptoms that indicate the presence of a

particular diagnosis. They constitute clinical evidenc

that needs to be studied with regard to their represen

tation in practice. This also includes related factors tha

can predict a diagnosis, such as etiological agent

(NANDA International [NANDA-I], 2009).

Accurate diagnostic inferences increase the effec

tiveness of care by permitting nurses to choose specifi

actions oriented toward the resolution and control o

identified problems. Conversely, interpretations of low

accuracy can lead to neglect of real or potential prob

lems and cause damage to the patient (Lunney, 2001).

Backgr ound The validation of diagnostic categories in population

and diverse clinical situations is important. Mos

likely, there will be language problems because thes

Nirla Gomes Guedes, R.N., M.S.N., is Doctoral Student, Nursing Professor, Catholic Faculty Rainha do Serta ì o,QuixadaŁ /CearaŁ , Brazil. Marcos Ven| ¤ cios de Oliveira Lopes, Ph.D., is Nursing Professor, Federal University of CearaŁ , Fortaleza/CearaŁ , Brazil. Thelma Leite de Araujo, Ph.D., is Nursing Professor, Federal University of CearaŁ ,

Fortaleza/CearaŁ , Brazil. Rafaella Pessoa Moreira, R.N., M.S.N., is Doctoral Student, Nursing Professor, Catholic Faculty Rainha do Serta ì o, QuixadaŁ /CearaŁ , Brazil. Larissa Castelo Guedes Martins, R.N., is Assistant Nurse, AlbertSabinHospital, Fortaleza/CearaŁ , Brazil.Correspondence to: Marcos Ven| ¤ cios de Oliveira Lopes, 1055, Esperanto St,Vila Unia ì o. Fortaleza -- CE/Brazil 60410-620. E-mail: [email protected]

193

Public Health Nursing Vol. 28 No. 2, pp. 193–200

0737-1209/r 2010 Wiley Periodicals, Inc.doi: 10.1111/j.1525-1446.2010.00902.x

mailto:[email protected]

mailto:[email protected]

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categories have been developed in other cultures;

consequently, there is a need to reconstruct these

categories to include a cross-cultural approach. The

sensitivity, specificity, and predictive value of clinical

indicators are factors that can contribute to the vali-

dation of this process.

Concerned with growing global sedentarism,NANDA-I realized the need for adding a diagnosis

that could better represent insufficient physical activity.

Existing diagnostic categories, such as ‘‘intolerance of

activity,’’ ‘‘fatigue,’’ ‘‘impaired physical mobility,’’

and ‘‘self-care deficit,’’ were all based on individuals

with various levels of physical injury (Damewood

& Carlson-Catalano, 2000). Some researchers have

proposed ‘‘deficit of physical activity’’ as a diagnostic

category related to a sedentary lifestyle, with its own

defining characteristics and related factors.

Sedentarism has also been suggested as a diagnostic

label and a content validation by Fehring’s method

showed a global content validation index of .84 for the

same (Guirao-Goris, Pina, & Campo, 2000). A comple-

mentary study identified two different related factors,

‘‘expression of laziness’’ and ‘‘low performance of activ-

ities of daily living,’’ that are similar to two defining

characteristics proposed by the NANDA-I taxonomy.

The high index of the ‘‘diagnostic content validation’’

among specialized nurses has also been highlighted

(Guirao-Goris & Duarte-Climents, 2007).

Interest in validating the nursing diagnosis

sedentary lifestyle in the NANDA-I arose due to a lack of diagnostic labels and prior taxonomies dealing with

human behavioral responses related to insufficient

physical activity. The diagnosis was recognized by

the NANDA-I in 2004; it was defined as, ‘‘reports

a habit of life that is characterized by a low physical

activity level.’’ The defining characteristics include the

following: chooses a daily routine lacking physical

exercise, demonstrates physical deconditioning, and

verbalizes preference for activities low in physical

activity. The related factors are deficient knowledge

of health benefits of physical exercise, lack of

training for accomplishment of physical exercise,

lack of resources (time, money, companionship,

facilities), lack of motivation, and lack of interest

(NANDA-I, 2009).

Because of the recent inclusion of these elements

in the NANDA-I taxonomy, the number of studies

dealing with sedentary lifestyle as a nursing diagnosis

is low. However, there are global concerns about

this lifestyle because it constitutes a health risk

capable of having severe consequences for the lives of

individuals, families, and communities. Therefore,

the defining characteristics and related factors of

sedentary lifestyle need analysis with regard to their

representation in clinical practice. Patients with high

blood pressure can serve as an example population

here. Adequate assessment of individuals with high blood pressure and sedentary lifestyles is essential for

improved quality of care because it directs assistance

toward the specific needs of these individuals.

Rese arch ques tion sThis is a study to evaluate the predictors of sedentary

lifestyle in people with high blood pressure. The

research questions for this study were as follows:

(1) what is the reproducibility of the defining char-

acteristics and related factors of the sedentary lifestyle

diagnosis in patients with high blood pressure; (2)

what are the sensitivity, specificity, and predictive

value of the defining characteristics; and (3) what

are the possible predictors of the nursing diagnosis

sedentary lifestyle in patients with high blood pressure?

Methods

Desi gn and sa mple A cross-sectional study was conducted among 310 indi-

viduals (ranging in age from 18 to 69 years) with

confirmed high blood pressure and who were followed

up in the hypertension program. Any medical contrain-dications for physical activity mentioned by individuals

were criteria for exclusion, as were cognitive problems

that rendered data collection of pertinent information

impossible. Ethical approval was obtained from the

internal committee of the institute.

Patients were consecutively selected and the sample

size was defined based on the indicated formula for

cross-sectional studies with finite populations using the

following parameters: confidence coefficient of 95% and

sample error of 5%; population size of 6,042 patients

with high blood pressure registered in the program;

and sedentarism prevalence of 70% (Murphy et al.,

2005). It was not possible to use prevalence of the

diagnosis as a reference in the study because this value

was not found in the literature related to patients with

high blood pressure.

Measur esPrimary data were collected on a questionnaire admin-

istered to individuals on entry into the study during

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a clinical consultation for follow-up of hypertension.

The questionnaire included variables related to the

assessment of defining characteristics and related

factors of the sedentary lifestyle diagnosis. The study

considered either the presence or the absence of the

diagnosis ‘‘sedentary lifestyle’’ as an outcome variable.

The long form of the International Physical Activity Questionnaire (IPAQ) was used in this study

(IPAQ, 2005; Benedetti et al., 2007). The question-

naire was divided into four parts. The first part was

designed to obtain personal and socio-demographic

data. The second part recorded behavior that related

to the habitual practice of physical activity, which

enabled the collection of data related to the defining

characteristics chooses a daily routine lacking physical

exercise and verbalizes preference for activities low in

physical activity.

The third part of the questionnaire assessed physical

conditioning by means of an instrument proposed

by the Cooperative Project-World Organization of

National Colleges and Academies (COOP/WONCA).

This instrument was validated for use in assessing

short-term physical conditioning processes and had

a Spearman correlation coefficient ranging from .66

to .81 (Tudela & Ferrer, 2002).

The fourth part of the questionnaire permitted

the collection of information concerning related factors

of the nursing diagnosis sedentary lifestyle. The instru-

ment facilitated gathering data related to possible

obstacles to practicing and understanding the relevanceof physical activities. In order to identify these barriers,

we used an instrument measuring the perception of the

difficulty of practicing physical activity. Testing showed

that the proposed questionnaire was satisfactory in its

applicability and clarity. It also permitted an acceptable

index of response reproducibility, with Pearson corre-

lation values ranging between .67 and .97 (Martins &

Petroski, 2000).

Specific knowledge about the importance of physical

activities was evaluated by calculating the number of

correct answers in 12 questions about physical activities

related to health that were proposed by InteliHealths

Inc. (InteliHealth, 2007). The information on the

Web site has been revised and approved by health

care professionals, the editors of InteliHealth, and

academic partners from Harvard Medical School and

the Columbia University College of Dental Medicine.

The questionnaire as a whole was subjected to

a pretest to verify its adequacy for measuring the

established objectives in the study and to inves-

tigate its ease of use. The resulting observations wer

incorporated and the final questionnaire wa

composed. The 14 individuals who participated in th

pretest were excluded from the final analysis.

An alyt ic st ra tegy

Studies of diagnostic tests usually include two analytical approaches: reproducibility and accuracy analyses

The first approach seeks to determine whether a mea

surement or a technique allows for the repeated identi

fication of a specific clinical condition. In studies o

clinical indicators for nursing diagnoses, the opinion o

specialist nurses is used as a way to assess the repro

ducibility of each indicator to characterize a diagnosis

For the purpose of making diagnostic inferences, dat

collected from each patient during the interview and

the list of defining characteristics and related factor

from the sedentary lifestyle nursing diagnosis wer

evaluated by three experts (A, B, and C) selected by th

Fehring criteria. At this stage, it is important to asses

agreement among the experts to minimize misclassi

fying subjects with either the presence or the absence o

the diagnosis. In this study, using the Kappa coefficient

concordance among experts was tested in the reproduc

ibility analysis regarding the presence or the absence o

the nursing diagnosis of a sedentary lifestyle and it

clinical indicators.

In nursing diagnosis research, the accurac

analysis is related to the confidence that a nurse ha

regarding the accuracy that a specific indicator wildetermine whether a patient truly has or lacks

particular diagnosis. Unfortunately, there are n

measures or techniques to serve as a gold standard

for the identification of nursing diagnoses. Thus, afte

verifying the classification and an agreement amon

experts, we decided to use agreement among expert

as the gold standard for identifying the presence of

sedentary lifestyle. This strategy was used to minimiz

bias on behalf of an expert’s individual opinion

During this stage, the sensitivity, specificity, an

predictive values were defined for each characteristic

For the analysis of the possible predictors of th

nursing diagnosis sedentary lifestyle, variables wer

analyzed using a t test with an assumption of equa

variances for the numerical variables. Assumptions o

normality and homoskedasticity were verified befor

performing the t tests. Pearson’s w2 test was used to an

alyze the categorical variables. The variables analyzed

included age, sex, birthplace, religion, marital status

occupation, educational level, income per capita, bod

Guedes et al.: Predictors of Sedentary Lifestyle 19

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mass index (BMI) classification, BMI value, time of

high blood pressure diagnosis, presence of diabetes,

defining characteristics, and related factors.

In the logistic regression the following were

included: variables that demonstrated statistical

significance lower than .2: age; presence of diabetes;

the three defining characteristics demonstrates physical deconditioning, chooses a daily routine

lacking physical exercise, and verbalizes preference

for activities low in physical activity; and the four

related factors lack of training for accomplishment

of physical exercise, lack of resources, lack of

motivation, and lack of interest .

From this selection, the variables were tested

to verify their overall association in order to clarify

the occurrence of the nursing diagnosis in question.

The Wald test was applied to verify the significance

of the coefficients that encompassed the logistic

equation. The Omnibus test verified the significance

of the developed model. The Hosmer-Lemeshow test

evaluated the difference between the observed and

the expected frequencies and the Nagelkerke R2 test

estimated the determined capacity of the model.

In addition to these statistics, the final definition

of the predictors considered the reduction of the

logarithm of the maximum likelihood ratio (À2log).

Results

The age, education level, and per capita income werenonnormally distributed. The median education was

9 years, the median per capita income was US$124.79

monthly, and the median age was 56 years. The

majority of individuals were female (65.5%), from

the capital Fortaleza (86.1%), Catholic (74.5%), and

married (64.5%).

With regard to concordance among the experts,

the defining characteristic demonstrates physical

deconditioning presented the lowest indices. The

other defining characteristics presented indices of moderate concordance. With regard to related factors,

deficient knowledge of health benefits of physical

exercise and lack of motivation presented the lowest

indices of concordance. The related factors lack of

training for accomplishment of physical exercise and

lack of resources demonstrated small variations

among the experts. Lack of interest was the related

factor of greatest concordance. Moderate levels of con-

cordance among the experts were observed in refer-

ence to the presence of the nursing diagnosis (Table 1).

The defining characteristic with the greatest sen-

sitivity was demonstrates physical deconditioning

(98.92%), which had a negative predictive value of

95.74%. Furthermore, chooses a daily routine lacking

physical exercise and verbalizes preference for activ-

ities low in physical activity presented greater values

of specificity (99.21% and 95.97%, respectively) and

high positive predictive values (99.24% and 97.09%,

respectively) (Table 2).

The variables that presented statistical signi-

ficance values below .2 for the nursing diagnosis of a

sedentary lifestyle were age ( p5 .044); presence of

diabetes ( p5 .048); and the related factors or definingcharacteristics chooses a daily routine lacking physical

exercise ( po.001), demonstrates physical decondi-

tioning ( po.001), verbalizes preference for activities

TABLE 1. Distribution of Concordance of the Experts (A, B, and C) Regarding the Presence or Absence of the Nursing Diagnosis Sedentary Lifestyle, Defining Characteristics, and Related Factors

Variable/experts

A ÂB A ÂC BÂC

Kappa Sig Kappa Sig Kappa Sig

1. Defining characteristics (DCs)

Chooses a daily routine lacking physical exercise .508 .000 .564 .000 .231 .000Demonstrates physical deconditioning .041 .011 .169 .000 .215 .000 Verbalizes preference for activities low in physical activity .531 .000 .307 .000 .574 .000

2. Related FactorsDeficient knowledge of health benefits of physical exercise .118 .000 .430 .000 .224 .000Lack of training for accomplishment of physical exercise .230 .000 .689 .000 .295 .000

Lack of resources (time, money, exercise companion or facilities) .300 .000 .342 .000 .743 .000Lack of motivation .112 .002 .127 .001 .736 .000Lack of Interest .727 .000 .728 .000 .923 .000

3. Presence of Nursing Diagnosis .411 .000 .414 .000 .730 .000


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low in physical activity ( po.001), lack of training for

accomplishment of physical exercise ( po.001), lack of

resources ( po.001), lack of motivation ( po.001), and

lack of interest ( po.001).

Among these variables, demonstrates physical

deconditioning, verbalizes preference for activities

low in physical activity, and lack of training for

accomplishment of physical exercise were identified

as significant predictive indicators. The logistic model

developed was statistically significant according to

the Omnibus test ( po.001), and it enabled the iden-

tification of the presence of the diagnosis from

these three variables of the model. No significant

differences were identified among the observed and

expected frequencies in the final model ( p5 .202).

The coefficients of each variable included in the model

demonstrated statistical significance according to the

Wald test ( po.05). The determination coefficient

of the model was .852; this coefficient implied that

the variables included in the model explained 85.2%

of the occurrence of the nursing diagnosis of a seden-tary lifestyle in patients with high blood pressure. This

fact was confirmed through the reduction of the

maximum likelihood ratio (À2 log) (Table 3).

Discussion

Studies have shown that the problem of physical

inactivity is a worldwide concern and indicated that a

large segment of the population does not follow current

recommendations regarding the practice of physica

activities (Altieri et al., 2004; Bernstein et al., 2001)

Worldwide inactivity justifies the creation and us

of the defining characteristic chooses a daily routin

lacking physical exercise (Hallal et al., 2005). Con

versely, a previous study has demonstrated that regula

physical exercise was associated with a significan

reduction in cardiovascular morbidity and mortalit

as well as an improvement in the cardiac illness reha

bilitation process (Lee & Skerrett, 2001).

A study comparing active and sedentary banker

found a relationship between the defining character

istics chooses a daily routine lacking physica

exercise and verbalizes preference for activities low

in physical activity. In the study, the active group

perceived regular physical exercise as a source o

pleasure because it afforded them the opportunit

to forget work-related problems. Conversely, thos

who were considered sedentary verbally reporte

preferring activities with little physical exercise du

to a lack of motivation. Instead, they opted for activities that were calming and less physically strenuou

(Andrade et al., 2005).

The fact that the defining characteristic demon

strates physical deconditioning was the greates

sensitivity measure for the sedentary lifestyle diagno

sis is likely due to the simplicity and clarity of the

individual self-evaluation tool. The findings should b

viewed with caution because effective physical fitnes

depends on the thorough execution of well-planned

TABLE 2. Sensitivity Value (SE), Specificity Value (SP), Positive Predictive Value (PPV), and Negative Predictive Value (NPV for the Defining Characteristics of the Sedentary Lifestyle

Defining characteristics SE (%) SP (%) PPV (%) NPV (%

Chooses a daily routine lacking physical exercise 69.35 99.21 99.24 68.51Demonstrates physical deconditioning 98.92 36.29 69.96 95.74 Verbalizes preference for activities low in physical activity 89.78 95.97 97.09 86.23

TABLE 3. Logistic Regression for the Predictive Factors of the Presence of the Nursing Diagnosis of a Sedentary Lifestyle

Predictors OMN HL R2À2 log Wald

o.001 .202 .852 219.511Demonstrates physical deconditioning .00 Verbalizes preference for activities low in physical activity o.00Lack of training for accomplishment of physical exercise o.00Constant o.00

Note. OMN5Omnibus test; HL 5Hosmer and Lemeshow test; R25Nagelkerke R2; 2log5Logarithm of likelihood ratio

Wald5 Wald test.


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activities and is influenced by the initial level of cardio-

vascular fitness of the individual as well as the type,

velocity, frequency, duration, and intensity of the

fitness session (Mcardle et al., 2006). In the present

study, a demonstrates physical deconditioning defin-

ing characteristic was tied to a chooses a daily routine

lacking physical exercise characteristic, which may result in an individual’s preference for activities with

little physical exertion.

Despite the low indices of concordance for deficient

knowledge of health benefits of physical exercise

among the experts, the literature highlights the fact that

a knowledge deficit about exercising, the purpose of

exercise, the limitations of some populations (as well as

distorted perceptions), and the benefits of movement is

one reason why individuals have sedentary lifestyles.

Conversely, increasing knowledge about physical

activity can prevent an increase in sedentarism

(Domingues & Araujo, 2004). Patients’ knowledge

about their health conditions, therapeutic treatments,

and prevention can facilitate adherence to regimens

and to maintenance of or improvement in well-being.

Additionally, patients can avoid changes in overall

health due to uncontrollable blood pressure levels.

Finally, lack of knowledge, motivation, and interest

in physical activity were also considered important

elements in understanding the adherence of high

blood pressure patients to physical activity programs

(Chummun, 2009).

Another topic that merits discussion is a relatedfactor: lack of training for the accomplishment of

physical exercise. This variable is an important etiologic

factor when considering the diagnosis of a sedentary

lifestyle in patients with high blood pressure. After a

period of training, patients with slight-to-moderately

high blood pressure who regularly perform dynamic

exercise can achieve a significant decrease in their

diastolic and systolic pressures during periods of both

rest and stress (Chobanian et al., 2003; Pitt et al., 2003).

These data may suggest the promotion of activities that

do not require training, such as walking.

In addition, regular training programs also pro-

vide better physical fitness for individuals and create

sustainable mechanisms for maintaining daily physi-

cal exercise routines (thereby increasing activity).

This relationship was demonstrated in this study,

in that the characteristics or factors chooses a daily

routine lacking physical exercise, demonstrates

physical deconditioning, and lack of training for

accomplishment of physical exercise increased the

probability that patients with high blood pressure

would develop a sedentary lifestyle.

With regard to the related factor lack of resources,

the findings demonstrated that interference from

family, friends, health care professionals, climate,

structure, time availability, and financial resources

influenced adherence to physical fitness regimens.Stimulation of patients with high blood pressure to

develop a more active lifestyle represents a valuable

tool for improving health standards. To become more

active, patients need to be educated and receive

adequate information and motivators. They also need

to belong to physical fitness groups and have access to

favorable conditions (e.g., financial resources, free time,

and nearby fitness locations). In the present study, the

factor lack of resources was not predictive, but it is

important in clinical practice. In the institution where

the study was developed, patients received all medi-

cations and had free access to all services; this may have

influenced our results.

In addition, analyses of the sensitivity and speci-

ficity of the defining characteristics in this investigation

indicated that demonstrates physical deconditioning

was the most sensitive variable; in contrast, chooses a

daily routine lacking physical exercise and verbalizes

preference for activities low in physical activity were

the most specific variables for the nursing diagnosis

under study.

Of the proposed characteristics for the diagnosis

of sedentarism, a previous study demonstrated thatverbal expression of the family of having a sedentary

lifestyle and verbalizing a preference for activities

with low or no physical activity yielded scores with a

diagnostic content validation superior than or equal

to 80; these scores were considered critical or specific

(Guirao-Goris et al., 2000). Conversely, the charac-

teristics realizes exclusively operational activities

of daily living and diminished capacity to execute

physical activity: poor physical conditioning (COOP/

WONCA score ! 3) had scores lower than 80 and

were classified as minor defining characteristics.

In a similar investigation by Guirao-Goris

and Duarte-Climents (2007), no characteristic had a

diagnostic content validation greater than 80. In

contrast, the characteristics verbal expression from

the family and/or a person of having a sedentary

lifestyle, verbalizes preference for activities with low

or no physical activity, and the presence of a COOP /

WONCA score ! 3 received higher scores of 70, 74,

and 73, respectively.


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Consequently, we believe that the differences

between specificity and sensitivity, which are influenced

by the diagnostic prevalence, directly depend on the

characteristics of the studied population. There is a

need to further investigate this hypothesis in diverse

population contexts to better clarify this question. For

Tanner and Hugles (1984), the relationship betweenthe clinical indicators and diagnosis could only be

validated after repeated and systematic observations

that required the development of new research with

additional subjects.

Although the classification of the physical activity

level by the IPAQ has the advantage of offering

an evaluation of physical activity in diverse contexts,

it is necessary to consider the potential recall bias

of the participants. Because of the length and detail

of the questionnaire with regard to the number and

period of executed activities, we concluded that

participants at times only estimated these values. This

estimation made it difficult to capture reliable infor-

mation fundamental for the development of the study.

Regarding the validity and reliability of these mea-

sures, we used standard techniques and calibrated

instruments for our clinical assessment. Moreover,

observation and evaluation biases are usually present

in studies of this nature. These biases can be associated

with different levels of experience and knowledge, the

omission of clinical data, lack of attention, and prema-

ture inferences. Despite the experience and selection

criteria used, one cannot guarantee that bias will not be present. In addition, it is necessary explain that

cross-sectional studies cannot show direction or cause.

Thus, the results should be considered in the context of

their limitations.

Unfortunately, data related to levels of hyperten-

sion and the use of medications were not investigated

because the study institution primarily serves indi-

viduals with severe hypertension (SBP4179 and/or

DBP4109). This limitation should be considered when

generalizing the results, and further studies investi-

gating the relationship between a sedentary lifestyle

with these variables are encouraged.

Another point to consider is the lack of studies

regarding the nursing diagnosis sedentary lifestyle.

This dearth made it difficult to compare and discuss

findings relevant to this research. This fact increases

the importance of developing new studies that involve

this nursing diagnosis.

The defining characteristic with greatest sensitivity

for the sedentary lifestyle diagnosis was demonstrates

physical deconditioning. The characteristics chooses a

daily routine lacking physical exercise and verbalize

preference for activities low in physical activit

showed the greatest specificity values. The indicator

identified as predictors of sedentary lifestyle wer

demonstrates physical deconditioning, verbalizes pref

erence for activities low in physical activity, and lacof training for accomplishment of physical exercise.

This study serves as a guide for the diagnosti

efficiency of clinical indicators for the sedentar

lifestyle diagnosis and contributes to improving diag

nostic accuracy by determining sensitivity, specificity

and positive and negative predictive factors. We cal

attention to the fact that the accuracy in question ha

not been sufficiently investigated in studies regardin

nursing diagnoses. We recognize the need to develop

studies examining the sedentary lifestyle diagnosis

Such studies are fundamental in order to better delin

eate the defining characteristics, develop more accurat

measurement instruments, and conduct clinical vali

dation in other contexts.

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