PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
DISSERTATION PROPOSAL
“A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE REGARDING THE EFFECT OF YOGA IN REDUCING THE RISK OF CARDIAC DISEASES AMONG ADULTS IN SELECTED URBAN AREAS OF TUMKUR WITH A VIEW TO DEVELOP AN INFORMATION GUIDE SHEET”.
SUBMITTED BY:
Mr. ANANTHAKRISHNAN
1st year M.Sc. NURSING
MEDICAL SURGICAL NURSING
SHRIDEVI COLLEGE OF NURSING
TUMKUR
(2011-2013)
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE
BANGALORE, KARNATAKA
ANNEXURE-II
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Mr. ANANTHAKRISHNAN,1st year M.Sc. NURSING,
MEDICAL SURGICAL NURSING,
SRIDEVI COLLEGE OF NURSING,
TUMKUR.
2 / NAME OF THE INSTITUTION / SRIDEVI COLLEGE OF NURSING
3 / COURSE STUDY AND SUBJECT / 1ST YEAR M.sc NURSING
MEDICAL SURGICAL NURSING
4 / DATE OF ADMISSION TO COURSE / 01-07-2011
5 / TITLE OF STUDY / “A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE REGARDING THE EFFECT OF YOGA IN REDUCING THE RISK OF CARDIAC DISEASE AMONG ADULTS IN SELECTED AREAS OF TUMKUR WITH A VIEW TO DEVELOP AN INFORMATION GUIDE SHEET”
6. BRIEF RESUME OF INTENDED WORK
6.0 INTRODUCTION
“Yoga is a light, which once lit, will never dim. The better your practice, the brighter the flame.“
B.K.S. Iyengar
The number of patients living with heart failure has been increasing ,especially among the economically disadvantaged. Once established, symptoms of the disease may be minimized by optimal medical therapy, but it is rarely cured. Heart failure is a chronic disease, imposing a substantial clinical and economic impact on health care. According to the American Heart Association’s 2008 statistical update, the U.S. prevalence of heart failure in adults was approximately 5.3 million in 2005 1. Six years after a myocardial infarction the risk of developing heart failure for both men and women is one in five . The lifetime risk of heart failure occurring without an antecedent myocardial infarction is one in nine for men and one in six for women 2. The incidence of heart failure is greater in men, until after age 80 years when more women have the diagnosis, likely due to the higher life expectancy of women . Sudden cardiac death occurs at six to nine times the rate of the general population when heart failure is the diagnosis.2
Hypertension (HTN) is a common risk factor for heart failure with 75% of all hear failure cases having hypertension as an antecedent diagnosis. The lifetime risk of heart failure doubles for people with blood pressure greater than 160/90mm Hg compared to those with blood pressure less than 140/90mm Hg 3. There are insufficient data available to determine relative risk for persons with a systolic blood pressure between 140 and 160mm Hg. According to a study conducted in Minnesota, the incidence of heart failure has not declined during the past two decades; survival after onset has increased overall, with less improvement among women and elderly persons 4. Increased survival may be due to improved medications and treatment alternatives that have evolved during the past couple of decades. Similarly, improved heart failure survival, likely due to improved treatment options, may be responsible for the increasing numbers of people with advanced chronic heart failure. The European Society of Cardiology published a position statement in 2007 that defines the characteristics and treatment options for advanced chronic heart failure..4
Heart failure patients experience multiple symptoms including dyspnea, exercise intolerance, fatigue, pain, and clinical depression, which significantly reduce their quality of life 5. These symptoms limit functional capacity in patients with both systolic and diastolic heart failure. The incidence, morbidity, and mortality of heart failure remain elevated, despite effective medications and increased treatment options 6. However, studies support that interventions aimed at treating chronic symptoms of heart failure may improve quality of life and lead to an improvement in overall health-related outcomes Age is a risk factor for developing heart failure since incidence doubles approximately every 10 years of life . The number of people living with heart failure is also on the rise, which places an increasing burden on the Medicare system, according to a recent report from Duke University researchers 7. This large incidence of heart failure makes the investigation of the role of alternative therapies and primary prevention imperative. The addition of nontraditional treatment modalities may lead to better management of heart failure, with improved symptoms and quality of life7.
In addition to the pharmacologic treatment of heart failure exercise rehabilitation programs improve exercise capacity in cardiac patients . Among unconventional forms of mind/body exercise, yoga has gained immense popularity and appears to provide overall and specific benefit for cardiac patients . Currently, hundreds of medical centers in the United States offer yoga classes to their community members and patients. One of the reasons for yoga’s widespread appeal is that it may be adapted to a range of physical fitness levels. A suitably trained yoga therapist can modify postures and techniques to meet individual patient needs. Despite its emerging popularity as a form of exercise, only one study provides pilot data on whether the addition of yoga therapy improves symptoms or health-related quality of life exclusively in patients with compensated heart failure .Yoga is an ancient form of mind-body therapy that combines specific physical postures, or asanas, with breathing techniques called pranayama and meditation, dhyana, to create a sense of well-being 8
Yoga has been gaining immense popularity due to the short-term as well as long-term benefits that it provides. The aims of the yoga enthusiasts are extremely varied. Some are particularly inspired by theSpiritual Elementthat yoga provides others by the increasedFitness and Flexibilitythat it results in. Some people find solutions to suffering from variedHealth Disordersand there are others who achieve anAll-Round Developmentof a calm, stress-free mind and a fit body. Yoga is a system of physical and mental disciplines designed to foster the practitioner’s mental and physical health . Yoga typically includes a triad of exercises; physical postures known as asanas (denoting a static physical position); breathing exercise called pranayama, and some form of relaxation or meditation. Hatha yoga is the generic term for the practice of the physical postures (asanas) intended to improve physical health by balancing strength and flexibility. The philosophical aim of yoga is to be comfortable enough to practice meditation without physical or mental disturbance. The popularity of yoga has increased tremendously over the past two decades in the United States. It has evolved from an eccentric and misunderstood practice to a mainstream training available in most public and corporate fitness facilities. Approximately 15 million Americans have engaged in a yoga practice at least once for either wellness or specific health conditions Yoga classes are offered in 75% of all health clubs in the United States and held in yoga studios, community centers, hospitals, colleges, schools, preschools, and senior citizen centers . 9
The emerging research is legitimizing age old claims regarding the positive effects of yoga on stress reduction, anxiety, depression and a variety of other medical disorders including the management of hypertension .Studies of yoga therapy involving healthy subjects found that practicing various relaxing and calming yoga asanas blunted the normal physiologic response to artificially induced physical stress, as measured by changes in heart rate recovery, heart rate variability, blood pressure, and respiratory rate . Anxiety levels were lowered significantly in the yoga treatment. The physiological effects of a regular yoga practice combined with breathing exercises lead to improved muscle strength, flexibility, cardiovascular endurance, and pulmonary function in human subjects.10
6.1NEED FOR STUDY
“Yoga is thefountain of youth. You're only as young as your spine is flexible.”
Bob Harper
There were 123 adult congenital heart disease participants (58% female; mean age, 37 [SD, 13] years). The most common self-reported cardiac diagnoses were tetralogy of Fallot and transposition of the great arteries. Most patients did not report transportation or financial barriers to care, but did report the following: not wanting further surgery even if it was recommended (18%), not liking to think or talk about one's heart (17%), and not understanding doctors' information; 8% of patients inaccurately considered themselves to be "cured." With regard to healthcare behaviors, more than 80% of patients reported annual family physician and dentist visits, but 34% of patients were unaware when to seek urgent medical attention. Patients reported moderate to extreme concern about the following medical topics: heart rhythm problems (82%), infections (74%), and understanding treatment options (71%). Patients most often reported moderate to extreme concern about the following lifestyle and psychosocial topics: physical activity (77%), insurance (72%), assuming increased health responsibility (73%), diet (71%), mental health (60%), and death and dying (57%).11
Data from the National Health and Nutrition Examination Survey (NHANES) 2005–2008 indicate that 33.5% of US adults ≥20 years of age have hypertension (Table 7-1). This amounts to an estimated 76 400 000 US adults with hypertension. The prevalence of hypertension is nearly equal between men and women. African American adults have among the highest rates of hypertension in the world, at 44%. Among hypertensive adults, ≈80% are aware of their condition, 71% are using antihypertensive medication, and only 48% of those aware that they have hypertension have their condition controlled.12
The 2007 overall death rate from CVD (International Classification of Diseases 10, I00–I99) was 251.2 per 100 000. The rates were 294.0 per 100 000 for white males, 405.9 per 100 000 for black males, 205.7 per 100 000 for white females, and 286.1 per 100 000 for black females. From 1997 to 2007, the death rate from CVD declined 27.8%. Mortality data for 2007 show that CVD (I00–I99; Q20–Q28) accounted for 33.6% (813 804) of all 2 243 712 deaths in 2007, or 1 of every 2.9 deaths in the United States.12
A low-fat, high fibre vegetarian diet, an hour of yoga and a long walk reduce heart disease by 12%.Yoga reduces angian, chest pain and improves pumping of pure blood into the aorta by 30% walking reduces bad cholesterol, production of stress hormones Walking reduces bad cholesterol, production of stress hormones including Epinephrine by 31 %The prevalence of cornonary artery disease in India has increasedfrom 1% in 1960 to 11% in 2001.13
Mortality data were obtained from the Registrar General of India. In 1998 the annual death rate for India was 840/100,000 population. Cardiovascular diseases contribute to 27% of these deaths and its crude mortality rate was 227/100,000. Major differences in cardiovascular disease mortality rates in different Indian states were reported varying from 75–100 in sub-Himalayan states of Nagaland, Meghalaya, Himachal Pradesh and Sikkim to a high of 360–430 in Andhra Pradesh, Tamil Nadu, Punjab and Goa. Lifestyle data were obtained from national surveys conducted by the government of India. The second National Family Health Survey (26 states, 92,447 households, 301,984 adults) conducted in 1998–1999 reported on various demographic and lifestyle variables and India Nutrition Profile Study reported dietary intake of 177,841 adults (18 states, 75,229 men, 102,612 women). Cardiovascular disease mortality rates were correlated with smoking, literacy levels, prevalence of stunted growth at 3-years (as marker of fetal under nutrition), adult mean body mass index, prevalence of overweight and obesity, dietary consumption of calories, cereals and pulses, green leafy vegetables, roots, tubers and other vegetables, milk and milk products, fats and oils, and sugar and jaggery. As a major confounder in different states is poverty, all the partial correlation coefficients were adjusted for illiteracy, fertility rate and infant mortality rate. There was a significant positive correlation of cardiovascular disease mortality with prevalence of obesity (R=0.37) and dietary consumption of fats (R=0.67), milk and its products (R=0.27) and sugars (R=0.51) and negative correlation with green leafy vegetable intake (R=−0.42) (p0.05).14
Benefits of a yoga intervention were hypothesized to be synonymous with improved cardiovascular risk profiles, summarized by two physiological pathways .The mechanisms by which the practice of yoga can improve the insulin resistance syndrome related abnormalities and cardiovascular disease related outcomes are thought to involve two pathways. First, yoga may lead to down regulation of the sympatho adrenal system and hypothalamic pituitary adrenalaxis, thereby shifting autonomic regulation towards the parasympathetic system. In effect, yoga may cause decreased perceived psychosocial stress and levels of depression, improved mood and sleep patterns, improved insulin sensitivity and glucose metabolism, reduced cholesterol and triglyceride levels and subsequent weight loss in the form of reduced visceral fat. Second, by stimulating the vagus nerve directly, yoga may promote additional parasympathetic activation thus leading to decreased heart rate and blood pressure, improved heart rate .Exercise or physical activity strengthens the heart muscle and increases oxygen consumption. However, if you have heart problems, vigorous exercise can be dangerous. Gentle forms of yoga, on the other hand, are suitable alternatives. Yoga is often a component in programs to reduce stress and high blood pressure -- two risk factors for heart disease. It helps to reduce your heart rate, improve muscle relaxation and increase breathing capacity, explains the University of Maryland Medical Center15
Cardiovascular disease is the leading cause of death in the United States, according to the American Heart Association, or AHA. You are more at risk for heart problems if you have a family history of these conditions, are overweight or obese, have diabetes or high blood pressure, consume a high-fat diet or smoke. Exercises, such as yoga, can help reduce your risk of heart problems and help to treat them15
6.2 REVIEW OF LITERATURE:
The purpose of review of literature is to obtain comprehensive knowledge base and in depth of information from previous studies.
REVIEWS ARE DIVIDED AS FOLLOWING SUB HEADINGS: