An Experimental Study to assess the Effectiveness of Deep Breathing Exercise on Lowering of Blood Pressure among Secondary Hypertensive Patients in Selected Villages

 

Ms. Rekha Kumari

 

ABSTRACT:

Purpose of the study-The purpose of the study was to determine the effectiveness of Deep Breathing Exercises on lowering of High Blood Pressure among Secondary Hypertensive patients. Methodology- Quasi experimental design was selected.It is done by forming two separate groups i.e. Experimental group & Control group by randomization (chit method) enabling every individual to have equal chance to participate in the research. Deep Breathing Exercise as an intervention given to Experimental Group only withholding it from others in Control Group. The subjects in the Control and Experimental Group are similar in numbers and characteristics but the subjects in the Control Group receive no Deep Breathing Exercise or any experimental treatment/intervention at all.Blood Pressure readings which is the dependent variable on both the groups is seen before the treatment(intervention). Later, the intervention is carried out on experimental group only and after intervention observation of dependent variable is made on both the groups. The sample setting wasPanchayatan village, Greater Noida, Gautam Buddha Nagar, U.P for conducting the research study which has a population of about 3000 people and the people who meet our inclusion criteria were chosen assamples. The selected sample size of present study consists of 60 patients i.e.30patient in experimental group and 30 in control group. Result-The Homogeneity was checked in both the group in terms of Age, Eating Habit, Residential Area, Family History, Present Medical Condition, Past Medical Condition, Marital Status, Monthly Income, Diet, Salt Intake, Educational Status, Habits, Weight And Sleeping Pattern and it was found that these variables are not statistically significant on the baseline but both the groups have similar characteristics.so both the groups are comparable. The Analysis of effectiveness of Deep Breathing Exercises on lowering of High Blood Pressure among secondary hypertensive patients was checked by repeated measure ANOVA. It shown that from baseline Mean score of pretest Systolic Blood Pressure and SD in Experimental Group was150.47 ±6.137 and after 15 minutes of Deep Breathing Exercise as intervention, the post test mean and SD on first day was 147.63 ±21.442.On the second day post test mean and SD was 140.77±9.982. On the third day post test mean and SD was 138.40 ±9.658.On the fourth day post test mean and SD was 131.50 ± 8.316 and On the fifth day post test mean and SD 137.2 ± 7.50.Hence the p value in Experimental Group is <0.001.The Baseline Mean score of Pretest Systolic Blood Pressure and SD in Experimental Group was 91.30 ±3.678 and after 15 minutes of Deep Breathing Exercise as intervention, the post test mean and SD on first day was 85.40 ±5.899.On the second day post test mean and SD was 83.83±7.918. On the third day post test mean and SD was 84.63 ±5.968. On the fourth day post test mean and SD was 81.40 ± 8.764 and On the fifth day post test mean and SD79.50 ± 4.058.Hence the p value in Experimental Group is <0.001.This shows that there was gradual reduction in Systolic and Diastolic mean Blood Pressure and SD score after each intervention in Experimental Group. Which indicates that the reduction in Blood Pressure was not by chance but because of the intervention. Hence the score predicts that there was significance difference between pre and post interventional Blood Pressure score in Experimental Group. Conclusion: The study reviles that Deep breathing exercises were effective in reducing the systolic blood pressure and diastolic blood pressure among patients with secondary hypertension in experimental group as compare to the control group. Whereas there was no significant change in Systolic and Diastolic Blood Pressure in Control Group

 

 

 

INTRODUCTION:

Hypertension is often called a "silent disease" because people usually don't know that they have it. There may be no symptoms or signs. Nonetheless, it damages the body and eventually may cause problems like heart disease. Also it increases the risk of blindness and dementia and the number one cause of death in America. People of all ages and backgrounds can develop high Blood Pressure. The prevalence of Hypertension increases progressively with age¹.Breathing Exercises is one of the non-pharmacological modalities. It is known that regular practice of Breathing Exercises increases parasympathetic tone, decreases sympathetic activity, improves cardiovascular and respiratory functions, decreases the effect of stress and strain on the body and improves physical and mental health².

 

Deep Breathing increases blood and oxygen flow to the brain to function in its optimal state. It creates a connection between mind and body that can lead to greater self-awareness, mindfulness and clear thinking, improves circulation, which improves heart health, energy levels and helps the body eliminate toxins, as well as reduces stress. Hence practicing Deep Breathing Exercises influence autonomic functions and has therapeutic benefit to hypertensive patients and despite the important relationships between heart rate and Hypertension there is a lack of evidence supporting heart rate lowering as a therapeutic strategy in Hypertension. Therefore, this study is undertaken to find a Non-pharmacological method for managing Essential Hypertension by using Deep Breathing Exercises³.

 

According to WHO, the prevalence of Hypertension is found to be highest in Africa with prevalence rates over 40% whereas lowest prevalence in America with 35% for both sexes. Hypertension is ranked as third cause of disability and anticipated to increase to almost 30% by 2025. The World Health Statistics, 2012 states that out of 57 million global deaths in 2008, 36 million i.e. (63%) were due to non-communicable diseases (NCDs) and among them the largest proportion of NCD deaths is by Cardiovascular diseases (48%).

 

In terms of attributable deaths, Hypertension is reported to be the fourth contributor to premature death in developed countries and the seventh in developing countries⁴.

 

A Quasi-experimental pretest-post test design is selected for topic “effectiveness of Deep Breathing Exercise on Hypertension among patient with chronic renal failure” on 2016, April 25. In this study the researcher used mean arterial pressure (MAP) which is the study is conducted for a period of 4 weeks. Totally 60 sample with mild to severe Hypertension were selected for the study, among them 30 were allotted to interventional group and the remaining 30 to Control Group. Each day 10 subjects selected for interventional group and 10 for Control Group based on the inclusion and exclusion criteria. The researcher first checked the Blood Pressure of the subjects. The mean arterial pressure is taken for calculation. After the intervention, the researcher checked the Blood Pressure immediately (zero hour), at half an hour, and one hour later. It reveals that the obtained t’ value is significant at p<0.05 level in all levels of Blood Pressure measurements for zero hour, half an hour, and one hour later. Result is found that breathing exercises are effective in reducing the level of Blood Pressure⁵.

 

METHODOLOGY:

The study was conducted in Panchayatan village, Greater Noida, Gautam Buddha Nagar, U.P. Secondary hypertensive patients were selected through consecutive sampling technique by measuring Blood Pressure using Automated Sphygmomanometer.

 

Quasi experimental design was selected. It was done by forming two separate groups i.e.

 

Experimental Group & Control Group by randomization (chit method) enabling every Individual to have equal chance to participate in the research. Deep Breathing Exercise as an intervention given to Experimental Group only withholding it from others in Control Group. The subjects in the Control and Experimental Group are similar in numbers and characteristics but the subjects in the Control Group receive no Deep Breathing Exercise or any experimental treatment/intervention at all.

 

In our research design, subjects were randomly assigned to either the Experimental or the Control Group. Blood Pressure readings which is a dependent variable on both the groups is seen before the treatment (intervention). Later, the intervention is carried out on

 

Experimental Group only and after intervention observation of dependent variable is made on both the groups.

 

Investigator has taken 60 Secondary hypertensive patients, thirty in Experimental Group and thirty in Control Group were selected as the subject of the study. The data was collected from 07 April to 25 April 2017 in Panchayatan village, Greater Noida, Gautam Buddha Nagar, U.P. In the first phase, subjects who fulfilled inclusion criteria were selected consecutively and randomly assigned to either Experimental or Control group. Informed written consent was obtained from participants of the study after explaining the purpose of the study.

 

Secondary hypertensive patients in the Experimental Group were given Deep Breathing Exercise as an intervention for 15 minutes for 5 days before intervention pre test Blood pressure scores were recorded and after intervention post test Blood Pressure scores were recorded with the help of Automated Sphygmomanometer.

 

Secondary hypertensive patients in control group were not given any intervention for 5 days. Pre test Blood pressure scores were recorded and after 15 minutes post test Blood Pressure scores were recorded with the help of Automated Sphygmomanometer.

 

Data Analysis:

Sociodemographic characteristics were described using frequency and percentage.Trial version of Statistical Package for social science 16.0 was used to analyze the data. Inferential statistics involved comparison of both group by independent t test, ANOVA, Chi–square test and Spearman co-relation test.

 

RESULTS:

Sociodemographic characteristic of study participants are described in Table 1. There was no significant difference between control group and experimental group in terms of sociodemographic characteristics.

 

Table no. 1 Sociodemographic characteristics of study participants (N=60)

CHARECTERSTICS	EXPERIMENTAL GROUP		CONTROLL GROUP		TOTAL		Chi Square Value	P Value
	F	(%)	F	(%)	F	(%)
Family History
· Yes	18	60%	20	67%	38	63%	1.209	0.546
· No	12	40%	10	33%	22	37%
Present Medical Condition
· Yes	14	47%	11	37%	25	42%	0.617	0.061
· No	16	53%	19	63%	35	58%
Past Medical History
· Yes	19	63%	20	67%	39	65%	1.226	0.542
· No	11	37%	10	33%	21	35%
Marital Status
· Married	25	83%	27	90%	52	87%
· Unmarried	3	10%	0	0%	3	5%	3.277	0.194
· Widow	2	7%	3	10%	5	8%
Monthly Income
· >50000	3	10%	3	10%	6	10%
· 10000-50000	15	50%	9	30%	24	40%	5.39	0.25
· <10000	12	40%	18	60%	30	50%
Diet
· Veg	28	93%	28	93%	56	93%	0.002	0.694
· Non-Veg	2	7%	2	7%	4	7%
Salt-Intake
·  Less than 2300mg	0	0%	3	10%	3	5%
· 2300mg	17	56%	13	44%	30	50%	0.123	2.356
· More than 2300mg	13	44%	14	46%	27	45%
Educational Status
· Uneducated	5	17%	3	10%	8	14%
· Primary	9	30%	17	56%	26	43%	4.346	0.114
· Secondary	16	53%	10	34%	26	43%
Sleep
· Less than 8hrs	10	34%	11	37%	21	35%
· 8hrs	16	53%	14	46%	30	50%	0.838	0.658
· More than 8hrs	4	13%	5	17%	9	15%
Bad  Habits
· None	12	40%	9	30%	21	35%	1.23
· Smoking	10	34%	13	43%	23	38%
· Alcohol	7	23%	6	20%	13	22%		0.746
· Tobacco	1	3%	2	7%	3	5%
Weight
· Under<18.4	4	13%	2	7%	6	10%
· Normal(18.4-24.9)	14	46%	17	56%	31	52%
· Overweight (>25-29.9)	10	34%	9	30%	19	32%	2.933	0.569
· Obese (>30.0)	2	7%	2	7%	4	6%

 

Analysis of effectiveness Deep Breathing Exercise in Exercise on lowering the Blood Pressure in Experimental Group and Control group.

 

Table No. 2: Effectiveness of Deep Breathing Exercise on lowering the Blood Pressure in Experimental Group.                  N=60. n=30

GROUP	Blood Pressure Score (Mean  ±SD) EXPERIMENTAL						p  value
	Baseline Pretest	1st Day Post test	2nd Day Post test	3rd Day Post test	4th Day  Post test	5thDay Post test
Systolic Blood Pressure	150.47±6.137	147.63±21.442	140.77±9.982	138.40±9.658	131.50±8.316	137.2±7.50	<0.001
Diastolic Blood Pressure	91.30±3.678	85.40±5.899	83.83±7.918	84.63±  5.968	81.40± 8.764	79.50±  4.058	<0.001

 

Table No. 2 Shows the Baseline Mean score of pre  test Systolic Blood Pressure and SD in Experimental Group is150.47±6.137and after 15 minutes of Deep Breathing Exercise as intervention, the post test  mean and SD on first day is 147.63±21.442.On the second day post test mean and SD is  140.77±9.982. On the third day post test mean and SD is 138.40±9.658. .On the fourth day post test mean and SD is 131.50±8.316 and On the fifth day post test mean and SD 137.2±7.50.Hence the p value in Experimental Group is <o.001.The Baseline Mean score of pre test Diastolic Blood Pressure and SD in Experimental Group is 91.30 ±3.678 and after 15 minutes of Deep Breathing Exercise as intervention, the post-test mean and SD on first day is 85.40±5.899.On the second day post test mean and SD is 83.83±7.918. On the third day post test mean and SD is 84.63±5.968. On the fourth day post test mean and SD is  81.40 ± 8.764 and On the fifth day post test mean and SD79.50 ± 4.058.Hence the p value in Experimental Group is <0.001.

 

This shows that there is gradual reduction in Systolic and Diastolic mean Blood Pressure and SD score after each intervention in Experimental Group. Hence the researcher accept alternative hypothesis which indicates that Deep Breathing Exercise is effective in the reduction of Blood Pressure

 

Table No. 3: Effectiveness of Deep Breathing Exercise on lowering the Blood Pressure in Control Group.                          N=60, n=30

GROUP	Blood Pressure Score (Mean  ±SD) CONTROL						p  value
	Baseline Pretest	1st Day Post test	2nd Day Post test	3rd Day Post test	4th Day  Post test	5thDay Post test
Systolic Blood Pressure	148.8±6.6	147.20±7.332	148.63±6.936	149.20±6.835	150.53±6.996	151.0±7.9	0.03

Table no. 3 shows the baseline Mean score of pre test Systolic Blood Pressure and SD in Control Group is 148.8±6.6 and after 15 minutes of Deep Breathing Exercise as intervention, the post test mean and SD on first day is 147.20±7.332. On the second day post test mean and SD is 148.63±6.936. On the third day post test mean and SD is 149.20±6.835. .On the fourth day post test mean and SD is 150.53 ± 6.996 and On the fifth day post test mean and SD 151.0 ± 7.9. Hence the p value in control  group is 0.03.

 

The Baseline Mean score of pre test Diastolic Blood Pressure and SD in Control Group is 98.50 ± 14.616 and after 15 minutes of Deep Breathing Exercise as intervention, the post test mean and SD on first day is 92.40 ±6.495.On the second day post test mean and SD is 93.40±5.468. On the third day post test mean and SD is 92.00±6.131. .On the fourth day post test mean and SD is 92.67± 8.547 and On the fifth day post test mean and SD95.8±6.3.Hence the p value in control group is 0.363

 

This shows that there is no reduction in Systolic and Diastolic mean Blood Pressure and SD score in Control Group because no intervention was given.

 

Figure 1 shows the mean of pre-Systolic mean of the first day of Experimental Group and post -test mean Systolic scores of 5 days. The pre test Systolic reading in the Experimental Group on first day is 150.47, whereas the post-test Systolic readings on the first day is 147.63 , on second day is 147.2, 138.4 on the third day and 131.5 on the fourth day and the fifth day reading is 128.57. The graph shows marked reduction in post Systolic Blood Pressure when Deep Breathing Exercises were given as an intervention, whereas in the Control Group of pre-test Systolic reading on the first day came out to be 148.87, the post-test Systolic reading on the first day as 148.65 , on second day as 149.2, 150.53 on the third day and 151.9 on the fourth day and the fifth day reading is 128.57 and thus the graph shows no reduction in post Systolic Blood Pressure because Deep Breathing Exercises were not given as an intervention in the Control Group. Hence the researcher accept alternative hypothesis which indicates that Deep Breathing Exercises were effective in the reduction of Blood Pressure.

 

Line graph representation of estimated marginal mean of pre- post SystolicBlood Pressure of 5 days in experimental and Control Group.                            N=60 

 

 

 

 

Line graph representation of estimated marginal mean of postSystolicBlood Pressure of 5 days in experimental and Control Group.                             N=60

 

 

 

Figure 2 shows the mean of pre-Diastolic reading on the first day and post Diastolic reading in the Experimental Group and Control Group .On the first day pre-test reading came out to be 91.3, the post-test reading on first day is 85.4, on second day is 83.83, third day is 84.63 on the fourth day is 84.63 on the fifth day is 81.4 thus ,the graph shows marked reduction in post Systolic Blood Pressure when Deep Breathing Exercises were given as an intervention ,whereas in the Control Group of pre Diastolic reading on the first day in the Control Group which came out to be 98.5, on the first day of post-test as 92.4 , on second day as 93.4, 92 on the third day and 92 on the fourth day and the fifth reading is 92.67 and thus the graph shows no reduction in post Systolic Blood Pressure because Deep Breathing Exercises were not given as an intervention in the Control Group . Hence the researcher accepts alternative hypothesis which indicates that Deep Breathing Exercises were effective in the reduction of Blood Pressure.

 

 

DISCUSSION:

Hypertension i.e. Blood Pressure above 140/90 mm hg is a common problem worldwide due to many reasons such as Obesity, Habits, Family History, Present Medical or Surgical Condition, Past Medical or Surgical Condition, High Caffeine Intake and High Salt Intake. The implication of Deep Breathing Exercises helps in lowering of Blood Pressure among secondary Hypertensive patients.

 

CONCLUSION:

The study reveals that Deep Breathing Exercises were effective in reducing the Systolic Blood Pressure and Diastolic Blood Pressure among patients with secondary Hypertension in Experimental Group as compare to the Control Group. Whereas there is no significant change in Systolic and Diastolic Blood Pressure in Control Group.

 

 

REFERENCE:

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2.       G Vasuki, L M Sweety,Usefulness of Deep Breathing Exercise on Blood Pressure in hypertensive patients in Chennai;experimental analysis of hospital episode statistics.2017 feb.vol 16(Issue 2 Ver. IV) ;[about 4 pages]. Availablefrom:http://webcache.googleusercontent.com/search?q=cache:JwahRS1dbFoJ:www.iosrjournals.org/iosr-jdms/papers/Vol16-issue2/Version-4/K1602045962.pdf+&cd=4&hl=de&ct=clnk&gl=in

3.       G Vasuki, L M Sweety,Usefulness of Deep Breathing Exercise on Blood Pressure in hypertensive patients in Chennai ;experimental analysis of hospital episode statistics.2017 feb.vol 16 (Issue 2 Ver. IV); [about 4 pages]. Availablefrom;http://webcache.googleusercontent.com/search?q=cache:JwahRS1dbFoJ:www.iosrjournals.org/iosr-jdms/papers/Vol16-issue2/Version/K1602045962.pdf+ &cd=4&hl=de&ct=clnk&gl=in

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Received on 30.03.2018       Modified on 14.05.2018

Accepted on 19.06.2018       ©A&V Publications All right reserved