Effect of Exercise on Patients with Hypertension

Review of the Evidence

Introduction

In today’s world, people want quick fixes. If they are sick, they get medication without actually looking at the underlying causes. Americans are at a great risk of getting hypertension or high blood pressure. In 2013, one in three adults have high blood pressure, which means around 77.9 million people in the United States. Of those people, 47.5% do not have it under control (“High Blood Pressure, Statistical Fact Sheet”, 2013). Medication is not the only answer to treat high blood pressure. A question to evaluate is, in patients with hypertension, does exercising decrease their blood pressure compared to those patients who do not? Nurses, especially, have a big role to play in helping patients with hypertension. Education is one of the biggest ways that they can help. If exercise is beneficial, the nurses should tell them what to expect the change in blood pressure would be and what exercise type would help. This education will, hopefully, improve the patient’s behavior modification (Bengtson & Drevenhorn, 2003). The goal is to find ways to decrease blood pressure.

Review the Literature

The first of five articles found is aimed to find the effect of lifestyle change on weight and blood pressure. In this Quasi-experimental study, the researchers looked at 328 overweight housewives in the Klang Valley, Malaysia. Of the 328, 169 were in the intervention group. The intervention consisted of six months of a healthy diet and physical activity. The findings showed that there was a change in the intervention group in the systolic blood pressure (the top number) of 5.84 mm Hg, and the intervention group had higher numbers in weight loss (Kassim, et al., 2017).

The second article is find the effect that yoga has on blood pressure. This was a quasi-experimental design study that looked at 33 participants. These participants had to meet several different criteria in order to be considered for the study. They had to be over the age of 40, on a type of blood pressure medication, have a resting systolic BP of greater than 160 mm Hg or diastolic BP of greater than 105 mm Hg (Mizuno & Monteiro, 2013). Blood pressure was measured each month in the two groups (control and yoga group) for four months. Their findings show that the group with yoga had a significant decrease in SBP of around 5 mm Hg, whereas the control group stayed around the same measurements. They thought that yoga was a good alternative of blood pressure control compared to medication (Mizuno & Monteiro, 2013).

In the third article, the researchers used a randomized, parallel active-controlled study to find the benefit that yoga and lifestyle modification had on a person’s blood pressure (Thiyagarajan, et al., 2014). This study’s criteria was for the volunteers to be between the ages of 20 to 60. Both genders were allowed to participants, but there could be no known evidence of cardiovascular disease in each participant. The outcomes showed that the group with yoga after 12 weeks showed an improved blood pressure of 6 mm Hg, whereas the control group only showed a 4 mm Hg difference. The yoga group also had 13 participants go from prehypertensive to normotensive during the study (Thiyagarajan, et al., 2014).

The fourth article’s goal was to find what effect weight loss intervention had on body composition and blood pressure. This was a quasi-experimental design study. This study looked at women from 18-59 who had a BMI of 25.0 to 39.9 kg/m2. 121 women completed this study. The results were that both groups, control and intervention, after six months had around the same amount of change to their SBP of around 7 mm Hg. They found, as well, that it was hard after another six months to keep the same amount of decrease on their BP. Motivation was not well kept to maintain these lifestyle interventions (Fazliana, et al., 2018).

The final article was a correlation study aimed to find that mild exercise did decrease blood pressure in patients with hypertension. The participants were a mix of men and women that were split into two groups, control and intervention. These 20 participants all needed to have essential hypertension to be considered for the study. The control group had to agree to do no particular physical training, whereas the intervention group did (Urata, et al.,1987). The aim of the study was proven right. Mild exercise lowered the intervention group’s blood pressure of around 7 mm Hg, and the control group showed no real change (Urata, et al.,1987).

Synthesize the Best Evidence

From all five articles, there is clear evidence that exercise decreases blood pressure. The mean decrease of blood pressure shown from these is 6.17 mm Hg. Yoga, especially, seems like a good exercise of choice to help decrease one’s blood pressure. From this data above, there is a theme shown that weight loss and blood pressure go hand in hand with one another. The decrease in one leads to the decrease in another. Some of the studies, however, did not go into any detail about the weight loss side. Most of these studies were done over a longer period of time that is important to keep in mind as a nurse. If a patient gets discouraged that working out is not helping decrease their blood pressure, the nurse can show them a similarity of these studies that it takes time to improve blood pressure. These articles are very beneficial to the healthcare field to help find alternatives to medications, if a patient wishes to find another way.

Conclusion

With these articles in mind, one of the biggest things that nurses could do to help patients leaving the hospital, clinic, or doctor’s office, is to educate. Tell the patients how exercise can be beneficial, what change to expect on doing exercise, and how long it could take. Another thing that nurses could do with patients in the hospital is to make sure each patient with hypertension or the risk of hypertension should walk daily to get exercise in. It would have been beneficial to have a future study that is directly related to how nurses can help decrease blood pressure in hypertensive patients, since theses articles did not explain that aspect.

References

• Bengtson, A., & Drevenhorn, E. (2003, October 29). The Nurse’s Role and Skills in
• Hypertension Care. Retrieved from https://www.medscape.com/viewarticle/463185_4
• Fazliana, M., Liyana, A. Z., Omar, A., Ambak, R., Nor, N. S., Shamsudin, U. K.,
• Aris, T.(2018). Effects of weight loss intervention on body composition and blood pressure among overweight and obese women: Findings from the MyBFF@home study.
  
  BMC Womens Health,
  
  
  18
  
  (S1). doi:10.1186/s12905-018-0592-2
• High Blood Pressure, Statistical Fact Sheet. (2013).
  
  American Heart Association.
  
  Retrieved July 16, 2019, from https://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf (“High Blood Pressure, Statistical Fact Sheet”, 2013)
• Kassim, M. S., Manaf, M. R., Nor, N. S., & Ambak, R. (2017). Effects of Lifestyle Intervention towards Obesity and Blood Pressure among Housewives in Klang Valley: A Quasi-Experimental Study.
  
  Malaysian Journal of Medical Sciences,
  
  
  24
  
  (6), 83-91. doi:10.21315/mjms2017.24.6.10
• Mizuno, J., & Monteiro, H. L. (2013). An assessment of a sequence of yoga exercises to patients with arterial hypertension.
  
  Journal of Bodywork and Movement Therapies,
  
  
  17
  
  (1), 35-41. doi:10.1016/j.jbmt.2012.10.007
• Thiyagarajan, R., Pal, P., Pal, G. K., Subramanian, S. K., Trakroo, M., Bobby, Z., & Das, A. K. (2014). Additional benefit of yoga to standard lifestyle modification on blood pressure in prehypertensive subjects: A randomized controlled study.
  
  Hypertension Research,
  
  
  38
  
  (1), 48-55. doi:10.1038/hr.2014.126
• Urata, H., Tanabe, Y., Kiyonaga, A., Ikeda, M., Tanaka, H., Shindo, M., & Arakawa, K. (1987). Antihypertensive and volume-depleting effects of mild exercise on essential hypertension.
  
  Hypertension,
  
  
  9
  
  (3), 245-252. doi:10.1161/01.hyp.9.3.245

Appendix

Author(s)	Study Purpose	Study Design	Subjects	Data Analysis	Findings
1. Mohd Shaiful Azlan Kassim, , Mohd Rizal Abdul Manaf, Noor Safiza Mohamad Nor, Rashidah Ambak	Aimed to determine the effect of lifestyle change on weight and blood pressure	quasi-experimental design	328 obese and overweight low socioeconomic status housewives aged 18-59 years old in the Klang Valley	Data was analyzed to find the mean change in weight and BP. Data was analysed using IBM SPSS Version 20.0.  Paired-sample t-tests were used to find the beginning weight and Bp before intervention and then those after intervention. General Linear Model Repeated Measures were used to find the significance of the data found.	after six months of exercise, there was modest weight loss thus a small decrease in BP. The intervention group should a change in systolic BP of around 16 mm Hg and in the control group a change of 14 mm Hg
2.Julio Mizuno, Henrique Luiz Monteiro	Study was to find yoga’s effect on blood pressure	quasi-experimental design	33 individuals.(1) over 40 years of age, (2) be on medical and/or pharmacological blood pressure (BP) control treatment, (3) resting systolic blood pressure (SBP) < 160 mm Hg and/or diastolic blood pressure (DBP) < 105 mm Hg.	To find distribution, Shapiro Wilk test was used. Baselines of both groups were measured with the student t test. Pre and Post test interventions were measured with a Wilcoxon test. To analyze the data, the Statistical Package for the Social Sciences (SPSS) 13.0 and Prism 3.0.	The yoga group showed significant reduction in BP. The intervention group had about 5 mm Hg difference in SBP and the control group stayed the same.
3.Ramkumar Thiyagarajan, Pravati Pal, Gopal Krushna Pal, Senthil Kumar Subramanian, Madanmohan Trakroo, Zachariah Bobby and Ashok Kumar Das	benefit of yoga and standard lifestyle modification on blood pressure on individuals with prehypertension	randomized, parallel active-controlled study	Volunteers (20-60 years) of both genders without any known cardiovascular disease	The student t-test was performed to find the distribution in the data. Data analysis was performed using the Statistical Package for Social Sciences version 19.0 for Windows	The group with yoga and standard lifestyle changes showed more improvement on BP than the group with only standard lifestyle changes. In group that had yoga, there was a 6 mm Hg change and the group without yoga only had a change of around 4 mm Hg SBP.
4.Mansor Fazliana, Ahmad Zamri Liyana, Azahadi Omar, Rashidah Ambak, Noor Safiza Mohamad Nor, Ummi Kalthom Shamsudin, Narul Aida Salleh, and Tahir Aris	Goal of this case was to find the effectiveness of weight loss intervention on blood pressure and body composition	quasi-experimental design	overweight and obese housewives aged 18–59 years old	SPSS Statistics for Windows, version 22.0 was the structure used to analyze the tests. Baseline measurements were taken with an independent t test and then the Pearson correlation test was used for the correlations of those measurements. ANOVA was used to determine the boyd composition differences between the two groups.	Study shows that there was significant changes in blood pressure in the intervention group six months after the study but that it was not maintained twelve months after the study. In systolic blood pressure in the change in both groups was around 7.00 mm Hg difference from their state systolic blood pressure.
5.HIDENORI URATA, YOICHI TANABE, AKIRA KJYONAGA, MASAHARU IKEDA, HIROAKI TANAKA, MUNEH1RO SHINDO, AND KLKUO ARAKAWA	This study was aimed to provide that mild exercise can decrease blood pressure in patients with hypertension	Correlation study	20 essential hypertensive subjects (Japanese) were randomly divided into two groups. One group (n = 10; 4 men and 6 women; 51.4 ± 2.8 years of age) agreed to physical training the other group (n = 10; 4 men and 6 women; 51.0 ± 2.9 years of age) did no particular physical training and was followed once a week as the control.	Student’s t test They used the Pearson correlations tests to analyze their data. Along with an analysis of variance. The Student T test was the primary way that they analyzed their data.	The study was proven successful that mild exercise did in fact lower blood pressure significantly. After ten weeks, the group that exercised had a decrease of around 7 mm Hg, and in the group that did not exercise there was no real change shown.

---

This student written literature review is published as an example. See

How to Write a Literature Review

on our sister site UKDiss.com for a writing guide.

Review of the Evidence

Introduction

In today’s world, people want quick fixes. If they are sick, they get medication without actually looking at the underlying causes. Americans are at a great risk of getting hypertension or high blood pressure. In 2013, one in three adults have high blood pressure, which means around 77.9 million people in the United States. Of those people, 47.5% do not have it under control (“High Blood Pressure, Statistical Fact Sheet”, 2013). Medication is not the only answer to treat high blood pressure. A question to evaluate is, in patients with hypertension, does exercising decrease their blood pressure compared to those patients who do not? Nurses, especially, have a big role to play in helping patients with hypertension. Education is one of the biggest ways that they can help. If exercise is beneficial, the nurses should tell them what to expect the change in blood pressure would be and what exercise type would help. This education will, hopefully, improve the patient’s behavior modification (Bengtson & Drevenhorn, 2003). The goal is to find ways to decrease blood pressure.

Review the Literature

The first of five articles found is aimed to find the effect of lifestyle change on weight and blood pressure. In this Quasi-experimental study, the researchers looked at 328 overweight housewives in the Klang Valley, Malaysia. Of the 328, 169 were in the intervention group. The intervention consisted of six months of a healthy diet and physical activity. The findings showed that there was a change in the intervention group in the systolic blood pressure (the top number) of 5.84 mm Hg, and the intervention group had higher numbers in weight loss (Kassim, et al., 2017).

The second article is find the effect that yoga has on blood pressure. This was a quasi-experimental design study that looked at 33 participants. These participants had to meet several different criteria in order to be considered for the study. They had to be over the age of 40, on a type of blood pressure medication, have a resting systolic BP of greater than 160 mm Hg or diastolic BP of greater than 105 mm Hg (Mizuno & Monteiro, 2013). Blood pressure was measured each month in the two groups (control and yoga group) for four months. Their findings show that the group with yoga had a significant decrease in SBP of around 5 mm Hg, whereas the control group stayed around the same measurements. They thought that yoga was a good alternative of blood pressure control compared to medication (Mizuno & Monteiro, 2013).

In the third article, the researchers used a randomized, parallel active-controlled study to find the benefit that yoga and lifestyle modification had on a person’s blood pressure (Thiyagarajan, et al., 2014). This study’s criteria was for the volunteers to be between the ages of 20 to 60. Both genders were allowed to participants, but there could be no known evidence of cardiovascular disease in each participant. The outcomes showed that the group with yoga after 12 weeks showed an improved blood pressure of 6 mm Hg, whereas the control group only showed a 4 mm Hg difference. The yoga group also had 13 participants go from prehypertensive to normotensive during the study (Thiyagarajan, et al., 2014).

The fourth article’s goal was to find what effect weight loss intervention had on body composition and blood pressure. This was a quasi-experimental design study. This study looked at women from 18-59 who had a BMI of 25.0 to 39.9 kg/m2. 121 women completed this study. The results were that both groups, control and intervention, after six months had around the same amount of change to their SBP of around 7 mm Hg. They found, as well, that it was hard after another six months to keep the same amount of decrease on their BP. Motivation was not well kept to maintain these lifestyle interventions (Fazliana, et al., 2018).

The final article was a correlation study aimed to find that mild exercise did decrease blood pressure in patients with hypertension. The participants were a mix of men and women that were split into two groups, control and intervention. These 20 participants all needed to have essential hypertension to be considered for the study. The control group had to agree to do no particular physical training, whereas the intervention group did (Urata, et al.,1987). The aim of the study was proven right. Mild exercise lowered the intervention group’s blood pressure of around 7 mm Hg, and the control group showed no real change (Urata, et al.,1987).

Synthesize the Best Evidence

From all five articles, there is clear evidence that exercise decreases blood pressure. The mean decrease of blood pressure shown from these is 6.17 mm Hg. Yoga, especially, seems like a good exercise of choice to help decrease one’s blood pressure. From this data above, there is a theme shown that weight loss and blood pressure go hand in hand with one another. The decrease in one leads to the decrease in another. Some of the studies, however, did not go into any detail about the weight loss side. Most of these studies were done over a longer period of time that is important to keep in mind as a nurse. If a patient gets discouraged that working out is not helping decrease their blood pressure, the nurse can show them a similarity of these studies that it takes time to improve blood pressure. These articles are very beneficial to the healthcare field to help find alternatives to medications, if a patient wishes to find another way.

Conclusion

With these articles in mind, one of the biggest things that nurses could do to help patients leaving the hospital, clinic, or doctor’s office, is to educate. Tell the patients how exercise can be beneficial, what change to expect on doing exercise, and how long it could take. Another thing that nurses could do with patients in the hospital is to make sure each patient with hypertension or the risk of hypertension should walk daily to get exercise in. It would have been beneficial to have a future study that is directly related to how nurses can help decrease blood pressure in hypertensive patients, since theses articles did not explain that aspect.

References

• Bengtson, A., & Drevenhorn, E. (2003, October 29). The Nurse’s Role and Skills in
• Hypertension Care. Retrieved from https://www.medscape.com/viewarticle/463185_4
• Fazliana, M., Liyana, A. Z., Omar, A., Ambak, R., Nor, N. S., Shamsudin, U. K.,
• Aris, T.(2018). Effects of weight loss intervention on body composition and blood pressure among overweight and obese women: Findings from the MyBFF@home study.
  
  BMC Womens Health,
  
  
  18
  
  (S1). doi:10.1186/s12905-018-0592-2
• High Blood Pressure, Statistical Fact Sheet. (2013).
  
  American Heart Association.
  
  Retrieved July 16, 2019, from https://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf (“High Blood Pressure, Statistical Fact Sheet”, 2013)
• Kassim, M. S., Manaf, M. R., Nor, N. S., & Ambak, R. (2017). Effects of Lifestyle Intervention towards Obesity and Blood Pressure among Housewives in Klang Valley: A Quasi-Experimental Study.
  
  Malaysian Journal of Medical Sciences,
  
  
  24
  
  (6), 83-91. doi:10.21315/mjms2017.24.6.10
• Mizuno, J., & Monteiro, H. L. (2013). An assessment of a sequence of yoga exercises to patients with arterial hypertension.
  
  Journal of Bodywork and Movement Therapies,
  
  
  17
  
  (1), 35-41. doi:10.1016/j.jbmt.2012.10.007
• Thiyagarajan, R., Pal, P., Pal, G. K., Subramanian, S. K., Trakroo, M., Bobby, Z., & Das, A. K. (2014). Additional benefit of yoga to standard lifestyle modification on blood pressure in prehypertensive subjects: A randomized controlled study.
  
  Hypertension Research,
  
  
  38
  
  (1), 48-55. doi:10.1038/hr.2014.126
• Urata, H., Tanabe, Y., Kiyonaga, A., Ikeda, M., Tanaka, H., Shindo, M., & Arakawa, K. (1987). Antihypertensive and volume-depleting effects of mild exercise on essential hypertension.
  
  Hypertension,
  
  
  9
  
  (3), 245-252. doi:10.1161/01.hyp.9.3.245

Appendix

Author(s)	Study Purpose	Study Design	Subjects	Data Analysis	Findings
1. Mohd Shaiful Azlan Kassim, , Mohd Rizal Abdul Manaf, Noor Safiza Mohamad Nor, Rashidah Ambak	Aimed to determine the effect of lifestyle change on weight and blood pressure	quasi-experimental design	328 obese and overweight low socioeconomic status housewives aged 18-59 years old in the Klang Valley	Data was analyzed to find the mean change in weight and BP. Data was analysed using IBM SPSS Version 20.0.  Paired-sample t-tests were used to find the beginning weight and Bp before intervention and then those after intervention. General Linear Model Repeated Measures were used to find the significance of the data found.	after six months of exercise, there was modest weight loss thus a small decrease in BP. The intervention group should a change in systolic BP of around 16 mm Hg and in the control group a change of 14 mm Hg
2.Julio Mizuno, Henrique Luiz Monteiro	Study was to find yoga’s effect on blood pressure	quasi-experimental design	33 individuals.(1) over 40 years of age, (2) be on medical and/or pharmacological blood pressure (BP) control treatment, (3) resting systolic blood pressure (SBP) < 160 mm Hg and/or diastolic blood pressure (DBP) < 105 mm Hg.	To find distribution, Shapiro Wilk test was used. Baselines of both groups were measured with the student t test. Pre and Post test interventions were measured with a Wilcoxon test. To analyze the data, the Statistical Package for the Social Sciences (SPSS) 13.0 and Prism 3.0.	The yoga group showed significant reduction in BP. The intervention group had about 5 mm Hg difference in SBP and the control group stayed the same.
3.Ramkumar Thiyagarajan, Pravati Pal, Gopal Krushna Pal, Senthil Kumar Subramanian, Madanmohan Trakroo, Zachariah Bobby and Ashok Kumar Das	benefit of yoga and standard lifestyle modification on blood pressure on individuals with prehypertension	randomized, parallel active-controlled study	Volunteers (20-60 years) of both genders without any known cardiovascular disease	The student t-test was performed to find the distribution in the data. Data analysis was performed using the Statistical Package for Social Sciences version 19.0 for Windows	The group with yoga and standard lifestyle changes showed more improvement on BP than the group with only standard lifestyle changes. In group that had yoga, there was a 6 mm Hg change and the group without yoga only had a change of around 4 mm Hg SBP.
4.Mansor Fazliana, Ahmad Zamri Liyana, Azahadi Omar, Rashidah Ambak, Noor Safiza Mohamad Nor, Ummi Kalthom Shamsudin, Narul Aida Salleh, and Tahir Aris	Goal of this case was to find the effectiveness of weight loss intervention on blood pressure and body composition	quasi-experimental design	overweight and obese housewives aged 18–59 years old	SPSS Statistics for Windows, version 22.0 was the structure used to analyze the tests. Baseline measurements were taken with an independent t test and then the Pearson correlation test was used for the correlations of those measurements. ANOVA was used to determine the boyd composition differences between the two groups.	Study shows that there was significant changes in blood pressure in the intervention group six months after the study but that it was not maintained twelve months after the study. In systolic blood pressure in the change in both groups was around 7.00 mm Hg difference from their state systolic blood pressure.
5.HIDENORI URATA, YOICHI TANABE, AKIRA KJYONAGA, MASAHARU IKEDA, HIROAKI TANAKA, MUNEH1RO SHINDO, AND KLKUO ARAKAWA	This study was aimed to provide that mild exercise can decrease blood pressure in patients with hypertension	Correlation study	20 essential hypertensive subjects (Japanese) were randomly divided into two groups. One group (n = 10; 4 men and 6 women; 51.4 ± 2.8 years of age) agreed to physical training the other group (n = 10; 4 men and 6 women; 51.0 ± 2.9 years of age) did no particular physical training and was followed once a week as the control.	Student’s t test They used the Pearson correlations tests to analyze their data. Along with an analysis of variance. The Student T test was the primary way that they analyzed their data.	The study was proven successful that mild exercise did in fact lower blood pressure significantly. After ten weeks, the group that exercised had a decrease of around 7 mm Hg, and in the group that did not exercise there was no real change shown.

---

This student written literature review is published as an example. See

How to Write a Literature Review

on our sister site UKDiss.com for a writing guide.