A Quasi Experimental study to Evaluate the Effectiveness of Yoga Therapy and Physical Exercises on Stress and Blood Pressure among Adults with Hypertension Nanchiyampalayam, Dharapuram.

 

Mrs. P.Jasmine Sharmila¹, Mrs. J. Lakshmi Priya², Mrs. Vijayarani Prince³

¹Lecturer,  Bishops College of Nursing, C.S.I Mission Compound,Dharapuram-638 656.

² Professor , Bishops College of Nursing, C.S.I Mission Compound,Dharapuram-638 656.

³Principal , Bishops College of Nursing, C.S.I Mission Compound,Dharapuram-638 656.

 

ABSTRACT:

Stress usually occurs in normal part of life. But too much stress can lead to emotional, psychological, and even physical problems including heart disease, high blood pressure, chest pains, or irregular heart to beats. Reducing stress can help lower high blood pressure¹. This study was aimed to evaluate the effectiveness of yoga therapy and physical exercises on stress and blood pressure among adults with hypertension Nanchiyampalayam,  Dharapuram. The research approach used for the study was evaluative approach. The Quasi experimental non equivalent pre test post test control group design was used. The conceptual frame work of the study was based on the modified Imogine “King’s Goal Attainment Theory” (1981). Purposive sampling technique was used to select 60 samples for the study, 30 in experimental group and 30 in control group. The tool used for the study was sphygmomanometer and perceived stress scale Questionnaire to measure blood pressure and stress. The intervention was performing physical exercises for 30 minutes and yoga therapy for 30 minutes for a period of 15 days in the experimental group. The collected data were analyzed using descriptive statistics and inferential statistics. The paired ‘t’ value for systolic blood pressure was 10.04 which was significant at P<0.05 level of significance. The paired ‘t’ value for diastolic blood pressure was16.2 which was significant at P<0.05 level of significance. The paired ‘t’ value for stress was 21.6which was significant at P<0.05 level of significance. The independent ‘t’ value was 6.276 for systolic blood pressure and 3.87  for diastolic blood pressure and17.7  for stress .which were significant at P<0.05 level of significance. There is a positive correlation between stress and systolic blood pressure r = 0.516. There were significant associations between blood pressure and stress with demographic variables but diet and habit of doing exercise has no significant association with stress and blood pressure. The study findings revealed that physical exercises and yoga therapy were beneficial and there was a significant reduction in blood pressure and stress among adult in experimental group.

 

 

 

INTRODUCTION:

This modern world, which is said to be a world of achievements, is also a world of stress. One finds stress everywhere, whether within the family, business organization or any other social or economic contest. Right from the time of birth, until the last breath drawn, an individual is invariably exposed to various stressful situations. Stress happens whenever one’s mind and body reacts to some real or imagined situation. Since every situation or event in daily life causes some type or degree of stress, it is unrealistic and impossible to eliminate stress, totally from one’s life. Stress is a normal part of life. But too much stress can lead to emotional, psychological, and physical problems including heart disease, high blood pressure, chest pains, or irregular heartbeats. Out of which blood pressure is an emergency problem. Reducing stress can help to lower high blood pressure. Exercise generally decreases both the systolic and diastolic value by five to seven points, and the decrease can occur as early as three to four weeks after increasing activity level. Physical activity also assists with weight control and decreases blood cholesterol and glucose levels so that the risk of heart attack and stroke is lower, even if blood pressure is not reduced to normal levels. Maintaining a yoga practice can be a great way to reduce stress, stay in shape and calm the mind. But when it comes to stress relief, not all yoga poses are created equal for relief of stress. Some positions are particularly effective for promoting relaxation, tension relief and restfulness^2-5. Globally,7.1 million people die (12.8% of total deaths) due to hypertension, the prevalence being 972million in 2002,predicted to increase by about60%(1.56%billion)by 2025. The hypertension death rate per 100,000 population in Canada is 3.3%The prevalence of hypertension in India is low compared to world figures. In India, 23.10 per cent men and 22.60 per cent women over 25 years old suffer from hypertension, says the World Health Organization’s ‘global health statistics 2012’⁶ The comprehensive public evaluation of the prevalence of non communicable diseases in rural Tamil Nadu has concluded that the prevalence of hypertension is 14.8 per cent  under-30 population., this works out to 3,23,254 people with hypertension, Tamil Nadu hypertension rate 3,2 The prevalence of hypertension in Coimbatore is 9.3 per cent respectively in rural area , Tirupur branch president P. Ravichandran told The Hindu that about 17 % of the rural adult population (over 30 years of age) in the state suffering from hypertension.3,254,male 1,44,024,female-1,79,230. A recent survey by Nielsen has revealed that Indian women are the most stressed out  in the world 87% of our women feel stressed out most of the time⁷.

 

MATERIALS AND METHODS:

Research Approach:

An Evaluative  approach was adopted for this study.

 

Research Design:

The research design selected for the study was quasi experimental non-equivalent pre-test, post-test control group design.

 

Setting of the study:

The study will be conducted in Nanchiyampalayam, Dharapuram.

 

Population:

The target population selected for the study were adult with hypertension.

 

Sample:

The sample who were diagnosed as a hypertension and residing in Nanchiyampalayam are selected as samples.

 

Sample Size:

Sample size for the study was 60, 30 were in experimental group and 30 in control group.

 

Sampling Technique:

Non probability purposive sampling technique was used to select the samples for the study.

 

Instrument and Scoring Procedure

The instrument consists of 3 sections.

 

Part I:

It consists of demographic data such as Age, sex, education, occupation, monthly, income, diet, habit of alcochol, habit of tobacco chewing, habit of chewing, habit of doing exercise, duration of hypertension and duration of alcohol consumption, tobacco chewing and smoking.

 

Part-II:

The level of blood pressure classification for adults according to WHO.

 

Part- III:

The perceived stress scale (PSS) was used to assess stress.

 

Validity:

The validity of the tool was obtained from 4 community health nursing experts and 1 medical expert. The standard scales are considered valid. The accuracy of the sphygmomanometer was assessed by karl Pearson’s formula (r=0.9)

 

Reliability:

Reliability of perceived stress scale were established by internal consistency method using Karl Pearson formula (r=0.83).

 

Protection of Human Rights:

The research proposal was approved by the dissertation committee prior to conduct pilot study and main study. The written permission was obtained from the Counsellor of Nanchiyampalayam. Oral consent was obtained from each subject before starting the data collection. Assurance was given to the subjects that confidentiality of their details would be maintained.

 

Data Collection Procedure:

Data collection was done for a period of 6 weeks. The demographic variables and pre-test was done to assess stress and Blood pressure by using perceived stress scale and sphygmomanometer. Before intervention the blood pressure was checked daily for 3 days for both groups.(average value of blood pressure was taken). The yoga and physical exercises were taught and demonstrated by the researcher followed by samples were performed (Yoga and physical exercises) for 30 minutes for once in a day. This was continued for 15 days. The control group was observed with regular activities. On 16^th day onwards blood pressure was checked daily for 3 days for both groups and stress also assessed using perceived stress scale. The same procedure was followed to the second 15 samples from both groups. The data were collected from 60 samples. The collected data were analyzed and tabulated using descriptive and inferential statistics.

 

RESULTS AND DISCUSSION:

Regarding age, (3%) were in the age group of 35-40 years and (20%) were in the age group of 41-45 years,(27%)  were in the age group of 46-50 years and (50%)  were in the age group of 51-55 years in the experimental group. In the control group (6%)  were in the age group of 35-40years and (24%) of  were in the age group of 41-45 years and (20%)  were in the age group of 46-50 years, and (50%) were in the age group of 51-55years.Regarding sex (40%) were males and (60%) were females in the experimental group. In the control group (63%) were males and (37%) were females. Regarding duration of illness (7%) had illness for less than 1 year, (57%) had illness for below 5 years, (36%) had illness for more than 5 years in the experimental group and in the control group (17%) had illness for less than 1 year, (60%) had illness for below 5 years, (23%) had illness for more than 5 years. Regarding habit of tobacco chewing (40%) has the habit of tobacco chewing and(60%) has no habit of tobacco chewing in experimental group and in the control group (20%) has the habit of tobacco chewing and(80%) has no habit of tobacco chewing. Regarding habit of alcohol consumption(3%) has the habit of taking alcohol and(97%) has no habit of taking alcohol in experimental group and in the control group (6%) has the habit of taking alcohol and (94%) has no habit of taking alcohol. Regarding habit of smoking (6%) has the habit of smoking and (94%) has no habit of smoking in experimental group and in the control group (30%) has the habit of taking alcohol and (70%) has no habit of smoking.

 

Table : 1 Comparison of mean score, standard deviation, mean difference and paired ‘t’ value of pre test and post test level of stress and blood pressure in experimental group.                                                                                                                                                                                    n=30

df=29; p<0.05   S*-Significant

 

Table 1  depicts that the mean pre-test score level of stress in experimental group is 32(SD±3.6) and systolic blood pressure mean is142(SD±7.5) and diastolic blood pressure mean is 97(SD±3.94)and in post-test score level of stress in experimental group is 13(SD±2.6) and systolic blood pressure mean is130 (SD±5.24) and diastolic blood pressure mean is 85(SD±4.83 ) respectively. The ‘t’ value for stress was 21.6 and for systolic blood pressure 10.04 and for diastolic blood pressure 16.2.which was significant   p<0.05 level, which showed that yoga and physical exercise was effective in reducing stress and hypertension.

 

Table : 2Comparison of mean score, standard deviation, mean difference and independent ‘t’ value of  post test level of stress among hypertension adults between experimental group and  control group.                                                                                                                      n=60

df=58; p<0.05; S*-Significant

 

Table 2 depicts the mean post-test score of stress in experimental group is 13 and (SD± 2.6) in control group mean score is 28 and (SD±4.2) unpaired ‘t’ test is 17.7,the mean post-test score in experimental group is lower than the mean post-test score in the control group, which is significant at p<0.05 which showed that yoga and physical exercise is effective in reducing stress and blood pressure.

 

Table : 3 Comparison of mean score, standard deviation, mean difference and independent ‘t’ value of  post test level of  blood pressure among hypertension adults between experimental group and  control group.                                                                                                     n=60

df=58; p<0.05; S*-Significant

 

Table 3  depicts the mean post-test score of systolic blood pressure in experimental group is 130 and (SD± 5.24) in control group mean score is 139 and (SD±5.6) unpaired ‘t’ test is 6.276,the mean post-test score of diastolic blood pressure in experimental group is 85 and (SD± 4.83) in control group mean score is 94 and (SD±4.1) unpaired ‘t’ test is 3.87,the mean post-test score in experimental group is lower than the mean post-test score in the control group, which is significant p<0.05  which showed that yoga and physical exercise is effective in reducing stress and blood pressure in experimental group than the control group.  There is a association between systolic blood pressure and their selected demographic variables like age, sex, religion, educational qualification, occupation, monthly income, marital status, duration of illness, duration of treatment, habit of tobacco chewing, habit of alcohol and habit of smoking at P<0.05 but diet (χ²=30) and habit of doing exercise (χ²=30) has no significant association with their demographic variables.

 

CONCLUSION:

The present study was conducted to evaluate the effectiveness of   yoga therapy and physical exercises on stress and blood pressure among adults with hypertension. The results of the study revealed that yoga therapy and physical exercises were highly effective in reducing blood pressure and stress among adults. This study concluded that the physical exercises and yoga therapy should be followed routinely like a daily living activities which helps to maintain a good health.

 

IMPLICATIONS:

The findings of the study have certain important implication for nursing service, nursing education, nursing administration, and nursing research.

 

Nursing Service:

·      The nurse must conduct mass awareness programmes regarding yoga and physical exercise in adults.

·      Nurse can arrange free yoga camp for the people in the community area.

·      Learning materials like wall hangings, posters, charts can be made available in the   home regarding yoga therapy and physical exercises.

 

Nursing Education:

§    The nurse educator can orient the students regarding alternative for stress management.

§    Nurse Educators should motivate the students to do mini projects on measures to relieve stress and blood pressure among adults in the community.

§    Nurse educators should conduct workshops/ seminars to update the knowledge of students on yoga and physical exercise so that they can educate adults in the community.

§    Nurse educator can organize and encourage the nursing students to celebrate the world hypertension day and conduct rally to create awareness among general population in community settings.

 

Nursing Administration:

§    Nurse administrator can organize the in service education programme regarding various cutting edge technological advancement in the treatment of hypertension to all health care providers which create awareness and helps to provide early care.

§    Nurse administrator can conduct mass education programme by using variety of audio visual aids like television, computer, puppet shows on prevention of hypertension and stress, which would benefit to community.

§    Nurse administrator can prepare and distribute information booklets about yoga and physical exercise.

 

Nursing Research:

§    The study findings can be effectively utilized by the emerging nursing researchers to conduct further studies and improving the body of knowledge in nursing.

§    Students can do mini project on other aspects like prevalence of hypertension and preventing the complication.

 

RECOMMENDATIONS:

Based on the findings the following recommendations are stated

·      Longitudinal study can be done to assess the effectiveness of stress and physical exercise in reducing stress and blood pressure among professionals.

·      Comparative study can also be done between the effectiveness of various non pharmacological measures on reducing stress and blood pressure among adults.

·      Experimental study can also be done between the effectiveness of yoga and physical exercise in improving physical functioning.

·      Similar study can be replicated in a larger sample thereby findings can be generalized to a large population.

 

LIMITATION:

o  It was difficult for the researcher to gather the rural people to do the exercises and yoga daily.

o  The intervention would be more effective if it is given for 1 hour.

 

REFERENCES:

1.     Bajwa . K.K.J. A study of home based blood pressure monitoring . Nightingale Nursing Times. (2010 ) ; Pp: 37-41.

2.     Damayanthi M.  Life style modification of hypertension patient’s in the prevention of coronary artery disease. Nurses of India. (2013); Pp:8-11.

3.     Granath J, et. al. American journal of health promotion. (2006); Pp:112-35

4.     Mathar M. N., Stress management. Nightingale nursing times. (2009); Pp:36-41.

5.     Saptharishi. L.G. et al. Community based randomized controlled trial of Non-pharmacological Intervention in prevention and control of hypertension among young adults. Indian journal of community medicine. (2009); Pp:329-334.

6.     http://www.articles,Times of India,.com>by Shimona Kanwar in 26 Google Circle

7.     http://www.who int\mediacentre\news\releases\2012\world.statistics

 

 

 

Received on 23.08.2016          Modified on 02.09.2016

Accepted on 21.12.2016          © A&V Publications all right reserved