European Journal of Cardiovascular Medicine

Hypertension, or high blood pressure (BP), is defined as persistent systolic and/or diastolic BP equal to or above 140/90 mmHg. The worldwide prevalence of hypertension among adults (>25 years) was around 40% in 2008, with a slightly lower prevalence in high-income countries. In Sweden, approximately 2 million adults have hypertension and high BP is the most prevalent reason for visits to primary care. [1]

Hypertension is important not only because of its high prevalence, but also because it is the largest single modifiable risk factor for cardiovascular disease and mortality worldwide. Furthermore, the direct and indirect costs for treatment of hypertension and its consequences constitute a substantial economic burden for our communities. [2] The beneficial effects of lowering BP on morbidity and mortality are very well documented. A decrease in systolic BP (SBP) by 10 mmHg or diastolic BP (DBP) by 5 mmHg reduces coronary heart disease (CHD) events (fatal or nonfatal) by about a quarter, stroke by about a third and heart failure by about a quarter. [3]

According to WHO (2009), deaths as a result to non communicable diseases as hypertension will increase by 17% over the next decade, with the greatest increase in the African region (27%). However, primary prevention has been proposed as the 13 most cost effective approach to the emerging epidemic. [4] In 2003, a cross-sectional study by High prevalence in women (29.5%) compared to male (27.6%) and low level of awareness. [5] However, focus has been on communicable diseases in developing countries until recently as that similar study conducted in 2006 still showed a high prevalence with 32.3% of participants not having knowledge of the disease. [6]

Aerobic Exercise produces many of the same bodily sensations that often elicit anxiety reactions such as an increase in heart rate, respiration, and perspiration. [7] It has been suggested that mild repeated stressors may be health promoting by affecting neural networks that are shaped by prior experience, resulting in 26 altered regulations in response to future stress. [8] Researchers believe that by repeated exposure to anxiety related interceptive stimuli, through exercise, may therefore eliminate the fear response. [9] Benefits of aerobic exercise Although exercise is regarded, in most research, as a purely physiological stimulus its emotional effects depend intimately on social and other environmental cues as well as the expectations of the individual. [10-11]

The purpose of this case controlled study was to determine the effects of Resistance on BP and quality of life in patients in primary health care diagnosed with hypertension. Another aim was to investigate whether there is a difference in effect on BP and quality of life if resistance is practiced on a regular basis in a group led by a resistance instructor or if the patient practices a shorter resistance program individually at home.

Design: It is a prospective, cross-sectional and descriptive study.

Place: This study was conducted in the Department of Physiology, Tertiary Care Teaching Hospital over a period of 1 year.

Experimental study design was carried out with a sample of 180 participants. Participants were randomly allocated using sealed envelope method to receive either resistance training. Informed consent was taken from all the participants included in the study.

Subjects

The sample size was including 60 subjects.

Inclusion criteria-

• Either gender with age group of 30-60 years of hypertensive subjects according to JNC VIII (Systolic BP >140mmHG and Diastolic BP >90 mmHg) was included.
• The inclusive subjects should be non-alcoholic, non-smokers.

Exclusion criteria-

• Patient with secondary hypertension,
• Left ventricular hypertrophy,
• Recent myocardial infarction,
• Three or more risk factors of CVD,
• Unstable hypertension,
• Mentally unstable or uncooperative patients.
• Patients with history of liver disease, kidney disease and Diabetes were excluded.

Intervention

Hypertension subjects treated with resistance exercise

Methods:

One hundred and eighty subjects clinically diagnosed as stage-1 Hypertension were selected According to inclusion and exclusion criteria and conveniently into consisting of 60 subject. All groups were explained about the purpose of the study. Informed Consent was obtained from the subjects.

A total of 60 patients who fulfilled the selection criteria during the study were enrolled. The data were analysed, and the final observations were tabulated as below.

Table 1: Distribution of Gender

In table 1, of the 60 samples, 32 were males and 28 females, which correspond to 53.3% of male and the rest female in Group A. Group B only 31 were males and 29 females, which correspond to 51.6% of males. In Group C were 33 were males and 27 females, which correspond to 55.0% of males and 45.0% of females.

Table 2: Distribution of the number of subjects according to age group

In table 2, in this study, the maximum number of patients were in the age group of 51-60 years which were 43.3% (n =26) of total followed by age group 41–50 years having 35.0% (n = 21) followed by age group 30-40 years with 21.6% (n=13) in Group A.

Table 3: Mean Pulse Rate (beats/minute) of resistance exercise 

S: Statistically Significant.

It is observed from Table 3 that, pre-test of resistance exercise group Mean Pulse Rate is 79.52 ± 4.14 beats/min (Mean±SD) reduced to 76.36 ± 4.01 in post-test

Table 4: Mean SBP (mmHg) of resistance exercise 

              S: Statistically Significant.

It is observed from Table 4 that, of resistance exercise Mean Systolic Blood Pressure of pre-test 137.34 ± 6.36 mmHg (Mean±SD) is reduced to Post-test 134.65 ± 6.35mm of Hg (Mean±SD).

Table 5: Mean DBP (mmHg) of resistance exercise

It is observed from Table 5 that, pre-test of resistance exercise Mean Diastolic Blood Pressure 91.52 ± 4.45 mmHg (Mean±SD) is reduced to Post-test 88.45 ± 4.31 mm of Hg.

Table 6: Mean Peripheral vascular resistance (mmHg/min/mL) of resistance exercise

It is observed from Table 6 that, pre-test of resistance exercise Mean Peripheral vascular resistance reduced from 1444.34 ± 153.25 mmHg/min/mL (Mean±SD) to Post-test 1094.64 ± 133.64 mmHg/min/mL.

Table 7: Mean Baroreflex sensitivity of resistance exercise

It is observed from Table 7 that, pre-test of resistance exercise group Mean Baroreflex sensitivity increased from 6.35 ± 0.43 (Mean±SD) to Post-test 6.24 ± 0.45.

More important than the finding that dynamic resistance exercise may reduce resting blood pressure is the fact that this investigation did not show an increase in either resting systolic or diastolic blood pressure. Efficacy of aerobics was found in a study done by, which supports our result showing Aerobic exercise intervention significantly reduced Blood Pressure.

It is observed from Table 3 that, pre-test of resistance exercise group Mean Pulse Rate is 79.52 ± 4.14 beats/min (Mean±SD) reduced to 76.36 ± 4.01 in post-test. According to a study done by C.G. Cardoso, et al; (2010) hypotension was usually observed during waking periods, According to results of resisted exercise, the real importance regarding the role of resistance training in lowering blood pressure is whether it does so in individuals with high blood pressure. [12] It is generally believed that aerobic exercise training lowers resting blood pressure more in patients with moderate-to-severe hypertension, compared with individuals with mild hypertension. [13]

It is observed from Table 4 that, of resistance exercise Mean Systolic Blood Pressure of pre-test 137.34 ± 6.36 mmHg (Mean±SD) is reduced to Post-test 134.65 ± 6.35mm of Hg (Mean±SD). It is observed from Table 5 that, pre-test of resistance exercise Mean Diastolic Blood Pressure 91.52 ± 4.45 mmHg (Mean±SD) is reduced to Post-test 88.45 ± 4.31 mm of Hg. Furthermore, the study portrays that large numbers of patients (63.74%) fell into prehypertensive category with systolic BP (120–139 mmHg). With regard to diastolic BP, majority of the patients were in the prehypertensive (80–89 mmHg – 38.01%) and stage 1 hypertensive (90–99 mmHg – 40.94%) category.

It is observed from Table 6 that, pre-test of resistance exercise Mean Peripheral vascular resistance reduced from 1444.34 ± 153.25 mmHg/min/mL (Mean±SD) to Post-test 1094.64 ± 133.64 mmHg/min/mL. The present study showed that 67.68% of the patients were aware of the role of aerobic exercise in hypertension, of which 58.29% practiced aerobic exercise. The awareness of aerobic exercise was high, which may be due to an increased recommendation by a doctor and increased awareness through social media. However, patients failed to put aerobic exercise into practice despite the awareness which due to laziness or lack of time and lack of concern about one's health. Out of aerobic exercise, there was maximum awareness and practice of walking (51.50%) followed by cycling (4.5%). The reason for maximum awareness and practice of walking could be due to cost-effectiveness and commonly advised by doctors and relatives. The nutritional and behavioral measures recommended in the management of high BP improved the patients’ general health status, as they also have a beneficial effect on other cardiac risk factors frequently associated with hypertension. [14]

It is observed from Table 7 that, pre-test of resistance exercise group Mean Baroreflex sensitivity increased from 6.35 ± 0.43 (Mean±SD) to Post-test 6.24 ± 0.45.

The study revealed that awareness of the role of Resistance exercise in hypertension was 33.67%, of which 13.07% practiced pranayama and 9.50% practiced asana. Similar study depicted that there was awareness and practice of walking (90%) and yoga was only 11.9%. Impaired baroreflex sensitivity has been increasingly postulated to be one of the major causative factors of essential hypertension. A short period (3 months) of regular yogic practice for 1 h/day is effective in controlling BP in such individuals. [15]

There is statistically no significant difference in efficacies of treatment A, B and C. This study led to the inference that both aerobic exercise and Resistance exercises can equally reduce Blood pressure. Hence, both exercise programs may be suggested as an important component in the management of Type-1 Hypertension. Further studies could focus on long term benefits of physical therapy in this condition.

There was complete awareness of hypertension, but a lesser amount of awareness of the role of resistance exercise in hypertension. In comparison to resistance, huge numbers of patients were aware of the role of aerobic exercise in hypertension, but only few practiced them. However, there was less awareness of the role of yoga in hypertension and even lesser number of patients practiced them. This concern can be prevailed over by education and awareness program, seminars, or community visit, which will impart the knowledge of the role of resistance exercises with their benefits for hypertension or health to individual.

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