6.1. Need for the Study:
Inthe modern world each and every individual’s life has become stressful.This stressful life is directly affecting a common person. A common man is suffering from various psycho physiological disorders. In this busy life schedule man is not having the time to relax. As the world is moving towards the 21st century Cardiovascular diseases have became one of the leading cause of morbidity & mortality in developed countries. It is estimated that about 10 million deaths occurs due to cardiovascular diseases over the world .InIndia about 30,000 deaths have been reported each year due to hypertension. The prevalence of hypertension is 59.9 and 69.9 per 1000 in males and females respectively in urban population and 35.5 and 35.9 per 1000 population in males and females respectively in rural population. A study conducted in Chennai shows that in urban 54% and in rural about 40% people are affected from high blood pressure.1
Hypertension is a silent killer disease of modern civilized society and is a global problem. World health report of 1998 states that along with the medical treatment of hypertension non pharmacological measures like relaxation is effective in reducing blood pressure. If hypertension has not managed at correct time it can cause serious problems such as myocardial infarction, angina, coronary artery disease, stroke, and heart failure3
Coronary heart disease is estimated to be the most common cause of death globally by 2020.Epidemiological studies shows that there are significant geographical differences in the occurrence of hypertension and its complication both between and within countries. It is known that 95% of hypertension patient in community are essential and idiopathic etiology and only a small percentage have an identifiable cause. Epidemiological evidence also shows that there are several factors which play an important role in the development evolution and prognosis of hypertension. Some of them are non modifiable such as age, sex,ethnicity and heredity. And other modifiable factor are body weight salt intake alcohol intake, use of hormonal contraceptive drugs, sedentary life and psychosocial factors.2
In India the awareness of hypertension its risk factor and complications are very poor. Hence hypertension goes untreated and undiagnosed for along time. So it is essential for health personal to reduce the number of deaths occurring in the world due to high blood pressure and its complications.3Alternative treatment for hypertension includes recommendation for the lifestyle changes and medications.The modern medical system has replaced almost all the traditional system of medicine in different parts of the globe because of its rational basis. Alternative method for the reduction of high bood pressureincludestraditional medicine, herbs, and dietary modification.However rapidly increasing incidence of stress related ailments is facing a great challenge to the modern medical system. Yoga appears to make a vital contribution to the modern medical system.
Yoga is one among the six systems of Vedic,philosophy; yoga is a method by which one can develop ones inherent powers in a balanced manner.It offers the man to reach complete self realization. Yoga means uniting the individual spirit with the universal spirit. Yoga which is an experimental science provides a systematic methodology with its firm roots in a holistic philosophy which is in total harmony with nature. Yoga and meditation helps greatly in keeping ones blood pressure under controlexternally for people suffering from hypertension. Doctors suggest that walking helps to control blood pressure for controlling blood pressure. However besides walking one can practice certain simple yoga exercises.In yoga various asnas are practiced. Asna means a state of being in which one can remain physically and mentally steady calm quite and comfortable. Itdevelops the ability to sit comfortably in position for an extended period of time,an ability necessary for meditation.The asnas are postures which are performed in standing, sitting,supine and prone positions and makes the body flexible, clean on the one hand and its blood circulation and nervous system flewless.4
Shavasana is the simplest type of asna in yoga. It relaxes the whole psycho-physiological system of the body. Shavasana should ideally practice before sleep or particularly after dynamic exercises such as surya namaskara and when individual feel physically and mentally tired.Shavasana does not require much space or equipment. It needs airy place and determination of the aspirants to perform shavasana very easily. It is the regularity that enables one to improve and maintain high blood pressure through out ones life. Shavasana is the easiest and can be adopted by a common person in his day to day life as a relaxation technique in reducing stress and blood pressure.4The investigator in his experience has noticed that many of the alternative therapies are highly beneficial in reducing blood pressure among which yoga is very easy to practice. So the investigator felt that nurses need to use this in practice and educate clients about to be effective and free of side effects.
6.2 REVIEW OF LITERATURE
An experimental study was conducted on psychological relaxation therapy in essential hypertension efficacy and its predictors. Hundred and seventy one out patients with mild essential hypertension (male age 20-55 ) were examined before the treatment course (6 week) and by the end of 1 year follow up. Patients were randomized in to two groups The analysis of B.P dynamic during 6 week revealed significantly (p<0.001) SBP (-10.4 + 0.8) and DBP (-7.7+0.6).By the end of 1 year the control group BP practically returned to the initial level. B.P reduction has been found in 62% of patients in the main group and only 12% of patients of the control group.10
Effect of progressive muscle relaxation (PMR) on blood pressure &psychological status in clients with essential hypertension has studied in Taiwan. Twenty subjects recived PMR training once a week and practiced at home daily for 4 weeks. PMR training has an immediate effect on reducing systolic blood pressure.Results shows that 30 min of training in PMR produced a reduction in systolic BP was reduced from 3.70-6.5 mm hg. With an average of reduction of 5.44mmHg. Diastolic pressure dropped from 3.0-3.8 mm hg with an average of 3.48 mm Hg. Result showed that there were significant difference between the experimental & control group for each week9
A study was conducted on effectivenessof yoga biofeedback, & music therapy in management of hypertension 2003 in Mumbai. In this study asana like shavasana was practicedtwenty hypertensive patients(15 males and 5 females)underwent relaxation therapy programmed for a period of 4 weeks. To analyze the changes in cardiovascular & subjective responses to initial & follow up test paired t ’test was used. Day 1 (pre) mean 96.40, SD 4.661, probability 0.000, improvement 10.27%. It indicates that a significant decrease in diastolic blood pressure of about 10 mm Hg following relaxation therapy. Day 1 (pre) mean 149.80, 1st tail probability 0.000. , improvement 10.21%. This indicates a significant decrease of about 15 mm Hg in systolic blood pressure post relaxation therapy.5
A study was conducted to determine the effect of Shavasna on blood pressure of 60 antenatal mothers with pregnancy induced hypertension admitted in selected hospital. The samples were divided into two groups that are experimental and control group. In experimental group shavasana was given for 30 min twice a day for 7 days. Every day before and after shavasana BP was checked in sitting position and left lateral position. The major findings of the study was that Shavasana is an effective relaxation technique to control blood pressure in antenatal mothers with pregnancy induced hypertension.7
A study to determine the effectiveness of yoga on blood pressure and stress, a group of hypertensive patients in Thailand were studied with the experimental group showing significantly decreased mean stress scores and blood pressure heart rate and body mass index levels compared with the control group.Results demonstrate a statistically significant reduction of mean values of SBP, and DBP at weeks 2, 4, 6 and 8 (p < 0.01). In the experimental group both SBP and DBP gradually decreased from week 2nd of the experiment until approaching normal level at week 8th.8
6.3 Statement of the Study
“A study to assess the effectiveness of relaxation therapy to reduce the blood pressure in hypertensive patients in a selected Urban Area at Mangalore”.
6.4. Objectives of the Study:
- To determine the blood pressure of the patient before therapy.
- To evaluate the effectiveness of relaxation therapy on reduction of blood pressure.
- To find out the association of blood pressure with selected demographic variables.
1. Effectiveness: Effectiveness is a compound of other qualities rather then a quality of its own. In this study it refers to usefulness of ‘shavasna’ in terms of significant reduction of systolic and diastolic bloodpressure.
2. Hypertension: It refers to an high blood pressure above normal that is 140/90 mm Hg as diagnosed by physician.
3. Relaxation therapy: Relaxation can be defined as the absence of tension in muscle and a minimum or absence of inner chatter in our minds the thoughts and worries. In this study the relaxation therapy means “shavasna” yoga posture. It is type of asna in the yogic exercise. In Shavasna the person will be lying like a ‘shava’ or dead body that is leis supine and relaxes every muscle of the body. The person is made to lie down with the back on the ground. Relax the hands and legs. Listen the beating of the heart. Now be a witness to the entry as well as the exit of air through the lungs. See that the thumbs of the legs, fingers, soles of the legs, knees, ankles, leg muscles, buttocks, waist and back belly, chest, both the hands and the arms shoulders and face, all these must feel relaxed and experience the relaxation of these parts. Mental relaxation and in the end feel that the blood circulation system works quietly in a perfect manner.
6. Assumptions:
- Emotional arousal may lead to elevation of blood pressure.
- The client will be willing to participate in the study.
- As age increases risk for hypertension is more.
- Client who are able to understand instructions in English.
- This study is delimited to age group of 25-65 years of age people.
H1 :The mean blood pressure of the clients with hypertension after the relaxation therapy - ‘shavasna’ will be significantly lower than the mean of pre-test .
H2; There will be a significant associations of blood pressure score and selected demographic variables.
MATERIALS AND METHODS:
Source of Data:
- Males and females 25 - 65 years of age.
Quasi experienmental design with one group pretest post test control groupdesign.
EO1 X O2
C O3 O4
E = Experimental group
C = Control group
O1 = Pre test of experimental group
O2 = Post test of experimental group
O3 = Pre test of control group
O4 = Post test of control group
X= Shavasna, a yogic exercise in which the patient is made to relax..
7.1.2. Setting:
The study will be conducted at selected urban area of Mangalore.
7.1.3. Population:
Clients who arediagnosed by physician as having hypertension.
7.2 Method of data Collection:
7.2.1 Sampling Procedure:
Purposive sampling technique will be used to select the sample.
7.2.2. Sample Size:
In this study the sample size will 40 clients who are diagnosed with essential hypertension in a selected urban area of Mangalore. Among which 20 samples will be considered as experimental group and 20 to be in control group.
7.2.3. Inclusion Criteria:
- Males and females > 25 years of age and < 65 years.
- Patients having essential hypertension as diagnosed by physician.
- Pregnancy / lactating patients.
- client who are not willing to participate in study .
1. Observation check list to record blood pressure.
2.Demographic performa.
7.2.6. Data Collection Method:
1.The investigator undergoes training forshavasanain yoga center.
2. Prior to data collection permission will be obtained from the PHC concerned authority for conducting the study.
3. The subjects will be selected according to the selection criteria of the study.
4. On the first day blood pressure will be recorded and shavasana will be taught daily for 30 min to hypertensive patients in experimental group for about 4 weeks
5. Post test will be conducted after 4 weeks for both experimental andcontrol group and blood pressure will be recorded.
7.2.7. Data Analysis Plan:
Data would be analyzed using the descriptive and inferential statistics.
7.3. Does the study require any investigations or intervention to be conducted on patients or other humans or animals?
Yes, Shavasana a yogic exercise will be performed on the patient.
7.4. Has ethical clearance been obtained from your institution in case of 7.3 ?
Yes ethical clearance is obtained from the concerned authority.
8. / BIBLIOGRAPHY:
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- Agras W.S. Taylor, C.B. Kramer. H.C. Allen. R.A and Schneider J.A. A relaxation training. Twenty four hour blood pressure reduction. Archieves of General Psychiatry, 37, 859-863.
- Mrs. Shweta Josh. Effect of shavasana on lactation among the mothers. Experimental study was conducted to a study to determine the effect of shavasana on blood pressure of antenatal mothers with pregnancy induced hypertension admitted in selected hospitals of Pune city Nightingale Nursing Times Jan – 08, Pg. 60-61.
- Rugh McCaffery, Pratum Rukmi, Urai Hottha Kit Payoo Kasetsamboon. The effects of yoga on Hypertensive persons in Thailand. Histolic Nursing Practice, July –Aug. 2005, Pg. 173-179.
- Sheila Shree, Barbara L, Irvin, Huey – Shyan, Chun Lin Mar. Effects of progressive muscle relaxation on blood pressure and psychosocial status for clients with essential hypertension in Taiwan. Holistic Nursing Practice. Jan/ Feb. 2003, Page. 41-47.
- Kulkarni D.D. Orienting reflex in shavasana practice and shavasana actual imagery. A comparative study. Yoga Himamsa. Vol. XXXIV No. 1: 27-36, April 2002.
- Wen-Wen Li, Margaret I, Wallhagen and Erika S. Froelicher. Hypertension control predictors for medication adherence and gender differences in older Chinese immigrants. Journal of American Nursing @ 2007 Blackwell Publications. Pg. No. 326-335, October 2007.
- T.A,Aivazyan psychological relaxation therapy in essential hypertention efficacy and its predictors.yoga mimmamsa vol xxix no2 july 1990 pg 27- 39
- Nagrthna and dr H.R Nagendra integrated approach of yoga therapy for hypertension.in Vivekananda Kendra yoga therapy & research centre vkyrtc 1980 pg no 1-12.
- Blanchard E,B preliminary results from a controlled evaluation of thrmal bio feedback self regulation 1984 9(4);471-95
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