RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
A STUDY TO ASSESS THE EFFECTIVENESS OF RELAXATION
EXERCISE ON REGULATION OF BLOOD PRESSURE
AMONG HYPERTENSIVE CLIENTS ADMITTED
IN SELECTED HOSPITALS AT KOLAR
DISTRICT, KARANATAKA.
PROFORMA FOR REGISTRTION OF SUBJECT FOR
DISSERTATION
MR. PRAVEEN M
A.E & C.S PAVAN COLLEGE OF NURSING KOLAR-563101
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / MR. PRAVEEN M1st YEAR, M.Sc. NURSING,
A.E & C.S PAVAN COLLEGE OF NURSING,
CHENNAI BANGALORE BY PASS ROAD,
KOLAR- 563101.
2. / NAME OF THE INSTITUTION / A.E &C.S PAVAN COLLEGE OF NURSING,
KOLAR - 563101.
3. / COURSE OF STUDY AND SUBJECT / M.Sc NURSING.
MEDICAL SURGICAL NURSING
4. / DATE OF ADMISSION TO COURSE / 13th JUNE, 2008.
5. / TITLE OF THE TOPIC / A STUDY TO ASSESS THE EFFECTIVENESS OF RELAXATION EXERCISE ON REGULATION OF BLOOD PRESSURE AMONG HYPERTENSIVE CLIENTS ADMITTED IN SELECTED HOSPITALS AT KOLAR DISTRICT.
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
"Ill health of body or of mind,
Is defeat, health alone is victory
Let all men if they can manage it
Continue to be healthy" - Thomas Carlyle
“Silent water, It is said that they are deep and dangerous”. “A volcano is also quiet till interrupts with devastating results”. High blood pressure is somewhat such a situation and if left undetected and untreated it results in brain attack (stroke), heart attack, heart enlargement, heart failure and kidney failure. Unlike volcano, which cannot be predicted, high blood pressure can be detected in the silent phase and if treated adequately the hypertension volcano can be prevented from eruption.1
Hypertension is a major public problem worldwide and in developing countries is different from that in the developed countries. India is a very large populated and typical developing country, community surveys have documented that between three and six decades, prevalence of hypertension has increased by about 30 times among about developers by about 10 times among rural inhabitants, various factors might have contributed to their rising trend and among others, consequences of urbanization such as change in life style pattern, diet and stress increased population and shrinking employment have been implicated. 2
WHO (1999) reported that one out of every three deaths in India is due to heart disease. In India about 10% of adult urban and about 3 to 5% of rural population suffers from high blood pressure. 3
Hypertension or high blood pressure, a common disease in industrial societies, has reached epidemic proportions. Approximately 50 million Americans are hypertensive and, though it can affect anyone, the greatest incidence occurs among middle-aged and older individuals. In addition, generally more men than women and African Americans than Caucasians have hypertension. 4
Results from epidemiologic studies have associated low levels of physical fitness with hypertension, independent of body mass or obesity. 5 Often referred to as the silent killer, hypertension is a leading risk factor for stroke, myocardial infarction, chronic heart disease and renal failure. 6
Hypertension is defined as a repeated blood pressure reading of greater than 140/90 mm Hg with pressures over 120/80 now considered as pre-hypertensive and worthy of lowering, especially with non-pharmacoologic means. Hypertension is generally classified into one of two categories: essential and secondary. Although the cause of essential hypertension is unknown, it is believed to develop in individuals with certain hereditary variations in genes. In contrast, secondary hypertension is a consequence of a known etiology, thus results from other diseases such as renal artery stenosis, coarctation of the aorta, adrenocortical or benign tumors and hypokalemia. 7
Exercise alternating muscle contraction and relaxation, such as in walking, running and cycling produces a different blood pressure response than static or resistance exercise (in which the muscle contraction is held for more than a few seconds before relaxing, such as in strength training and isometric exercise). Although antihypertensive drugs reduce blood pressure, some may also dampen exercise performance. Non-pharmacologic interventions can serve as definite therapy for selected hypertensive patients and adjunctive therapy for many others. 8
Aerobic exercise and diet-induced weight loss have emerged as the most effective and physiologically desirable approaches. Studies have also indicated exercise training lowers blood pressure in individuals with essential hypertension and those taking hypertensive medications. Moderate intensity exercise can reduce both systolic and diastolic blood pressure by 7mmHg. A review by the National Institutes of Health (NIH) demonstrated that in 70 percent of all exercising subjects, blood pressure lowered an average of 10.5/8.6mmHg from an average starting level of 154/98mmHg. 9
Additionally, population of older hypertensive females, aerobic exercise training improved insulin sensitivity and lowered blood pressure without a reduction in plasma tumor necrosis factor levels. 10
There are several types of relaxation techniques to overcome stress, like meditation, progressive muscle relaxation, bio feed back, imagery and autogenic training. However the selection of exercise for each patient depends upon his or her choice and physical ability to tolerate. Relaxation is the need of the time. The present study aims to verify the immediate effects of relaxation exercise on blood pressure in hypertensive patients.
6.1 Need for the study
One of the leading causes of morbidity as well as mortality in most developed and developing countries today are cardiovascular disease.
At the opening meeting of the WHO expert committee on hypertension control meet at Geneva, it was pointed out that hypertension is the commonest cardiovascular disorders, posing a major public health challenges to societies in socio-economic and epidemiological transition. It is one of the major risk factors for cardiovascular mortality, which allocates for 20-50% of all deaths. The report also highlights that adults aged 40-55 years had higher levels of blood pressure and Indian men had higher levels as compared to those of 20 other developing countries. The meta analysis of Gupta agrees that, the prevalence of hypertension in India is almost similar to those in USA. He also agrees with the findings of the urban-rural difference in hypertension. The prevalence is more among urban population than rural population. 11
The prevalence of hypertension has increases by 30 times among the urban population over a period of 36 years. Various hypothesis have been put forward to explain this rising trend, consequences of urbanization such as change in life style pattern, diet and stress have been implemented. The current urbanization rate in India is 35% compared to 15% in the 1950. Undiagnosed prevalence of hypertension is more than 15 million (more than 30% of 50 million are undiagnosed). Undiagnosed prevalence rate for hypertension is approximately 5.51% of 15 million people in USA.
The report of the WHO expert committee for hypertension (WHO, 1996) and the VI Report of the Joint National Committee on prevention, detection, evaluation and treatment of high B.P. Non-pharmacological treatments as the first measure in the control of hypertension. A study suggested daily exercise like walking and relaxation exercises and meditation as the first measure in the control of mild hypertension12, only those who cannot achieve normal tension by use of exercise should initiate drug therapy and even while on drug therapy, he said that all patients must continue to follow non-pharmacological therapy all through. 13
Standard exercise methods and protocols may be used for individuals with hypertension. Graded exercise can reduce the degree of blood pressure response during exercise, rate of recovery and incidence of arrhythmias during the test. When undergoing a exercise, individuals should be taking their usual medications. A resting Systolic Blood Pressure equal to or greater than 200mmHg or a Diastolic equal to or greater than 115mmHg is considered a contraindication to exercise. During the test, if Systolic bold pressure rises above or equals 260mmHg or Diastolic rises above or equals 115mmHg, the test should be terminated immediately. 14
At about 20 to 60 minutes of aerobic exercise, three to five days per week, at 50 to 85 percent of maximal oxygen uptake is appropriate for individuals with mild hypertension. However, for individuals with hypertension, exercise should be at 40 to 70 percent of maximal oxygen uptake after patients begin pharmacological therapy. Resistance training is recommended as an adjunct to aerobic exercise. It should be performed independently, since research has not shown it can decrease blood pressure consistently, with the exception of circuit weight training. This type of training should use low resistance and high repetitions. The American Heart Association recommends mild to moderate resistance training at 30 to 60 percent of maximal effort for improving muscle strength and endurance. 15
An abundance of evidence suggests increasing physical activity in sedentary individuals and maintaining it in active ones can significantly impact hypertension. The amount of activity required for benefit is feasible for almost everyone. Counseling by health care providers is one important, but underutilized, method of encouraging adults to engage in physical activity and exercise. Moreover, physical activity opportunities in schools and communities should be encouraged for hypertension prevention and intervention across all age groups.
Though there have been studies showing the positive effects of stress reduction and relaxation by various means, their use is very limited in practice. The present study aims to verify the immediate effects of relaxation exercise on blood pressure in hypertensive patients. There have not been a study earlier on the same topic and the researcher is interested to promote the use of relaxation exercise in the treatment of hypertension. Most of all it does not involve financial burden either in learning or in its use. Minimum life style modifications are required. On the other side, life long drug therapy is a great financial burden to the people of our economically developing country. The drug therapy through effective has enormous amount of side effects and complications in the long run.
Based on the review of literature and personal experience of investigator during his clinical posting, found that in many hospitals hypertension is one of the common reported problem. Care of hypertension involves such as diet control, stress control, relaxation exercise, anti hypertensive drugs to control the blood pressure and prevention from complication. Hence the investigator is interested to conduct a study on effectiveness of relaxation exercise to control hypertension.
6.2 Review of Literature
The review of literature for the present study was done on both research and non-research materials. The review was considered under following three headings:
1. review related to High blood pressure and its effects on body.
2. review related to Stress – a contributing factor.
3. review related to The effects of relaxation on blood pressure.
1. Review related to High blood pressure and its effects on body.
A study conducted with objectives to determine the prevalence of essential and borderline hypertension in a population of blood donors and their families and to determine if there is a correlation between blood pressure and lifestyle and/or other cardiovascular risk factors. The diastolic blood pressure was dependent on BMI, heart rate, and alcohol in both sexes, and glycemia, LDL cholesterol, and uricemia in the men. In the second group, primary and borderline hypertension are significantly correlated with age, BMI, and uricemia in both sexes and glycemia in females. A program of health and nutritional education could modify some factors related to blood pressure, such as obesity and alcohol consumption. The result would be a reduction of the prevalence not only of essential and borderline hypertension, but also of metabolic diseases such as dyslipidaemias, diabetes and hyperuricemia, with a global reduction of the cardiovascular risk. 16
A study aimed to determine the frequency and risk factors of hypertension among individuals aged 50 years and over, and to examine its effect on the health related quality of life (HRQOL). A questionnaire concerning life habits associated with hypertension, medical histories, and demographic characteristics was filled by face to face interview. The overall prevalence rate of hypertension was 59.5% (n=710), being 58.0% in men and 60.9% in women. The variables that most positively influenced hypertension were older age, single, no health insurance, consumption of animal fat in meals, and family history of hypertension. The HRQOL of the patients with hypertension was lower than that of those without hypertension. The HRQOL was better in hypertensive patients whose blood pressure was under control, whereas it was worse in those with at least one chronic disorder accompanying hypertension. Great emphasis should be placed on the need for a public health program for the detection, prevention, and control of hypertension, including other risk factors, as well as for the modification of foods and life habits, specifically in individuals who are most likely to be at risk of hypertension. 17
Hypertension experts still debate on the level of blood pressure (BP) considered abnormal. A great deal of effort has been devoted to search for dividing line between normotension and hypertension. According to the study18 there is no dividing line between normotension and hypertension. The relationship between arterial pressure and mortality is quantitative, the higher the pressure the worse the prognosis. The report of WHO expert committee evidenced that hypertension as the level of B.P. at which detection and treatment do more good than harm. This level can be determined only by intervention trials demonstrating of benefits from blood pressure reduction. According to the study the currently accepted dividing line based on epidemiological and intervention studies are stated as systolic BP 140 mm-Hg and/or diastolic BP 90 mm-Hg.19
A study on prevalence of left ventricular hypertrophy in essential hypertension was done at Tirupati. Fifty patients with essential hypertension were studied by echocardiography and its correlation to ECG. The result showed the prevalence of left ventricular hypertrophy in essential hypertensive patients was 74% and it increased with age. Echocardiography is more sensitive than ECG as 76% of patients who had no ECG evidence showed left ventricular hypertrophy by echocardiography. 20
An article on mild hypertension states that easily determined signs of target organ damage are angina pectoris, prior myocardial infarction, prior coronary angioplasty or CABG surgery, congestive cardiac failure, stroke and renal failure. Sustained elevations in blood pressure have severe consequences even when they are considered to be mild elevations. 21