ORIGINAL ARTICLE
Year : 2016 | Volume
: 16 | Issue : 1 | Page : 47--52
Comparative study of effect of progressive muscle relaxation and walking on stress and cardiovascular profile in young adults of health sector
Arunima Chaudhuri1, Ayan Goswami1, Manjushree Ray2, Samir Kumar Hazra3, Shyamal Bera1,
1 Department of Physiology, Burdwan Medical College and Hospital, Burdwan, India
2 Department of Anaesthesiology, National Medical College, Kolkata, West Bengal, India
3 Department of Gynaecology and Obstetrics, Burdwan Medical College, Burdwan, India
Correspondence Address:
Arunima Chaudhuri
Department of Physiology, Burdwan Medical College and Hospital, Krishnasayar South, Borehat, Burdwan - 713 102, West Bengal
India
Abstract
Background: Stress has become a part and parcel of modern day life. Lifestyle modifications may be a cost-effective way to improve health and quality of life. Aims: To compare effects of progressive muscle relaxation (PMR) and walking on stress and cardiovascular profile in young adults working in the health sector. Materials and Methods: This pilot study was conducted at a tertiary care hospital of Eastern India after taking institutional ethical clearance and informed consent of the subjects. One hundred and twenty young adults from the health-care sector with the presumptive life event stress scale of more than 200 were selected for the study. Anthropometric measurements were carried out. Pulse and blood pressure were recorded. Perceived Stress Scale (PSS) scores were calculated, lipid profile analyzed, and isometric hand grip test, orthostatic tolerance test, and breath-holding test were done. Study subjects were divided into two groups G1 and G2. Group G1 was asked to practice PMR and Group G2 was advised to walk in the morning for 3 months. All parameters were re-evaluated after 3 months. The primary outcome measures from baseline to final follow-up were measured by blinded observers. Results: There was no difference in age, sex, PSS, cardiovascular profile, and dietary habits between the two groups before training. Ten subjects failed to attend follow-up clinic and were excluded. PSS, cardiovascular profile were significantly improved in both groups after the training session. PSS and cardiovascular profile improved equally in both groups. Conclusion: PMR and walking were equally effective in reducing stress and improving cardiovascular profile in young adults and may be used as a cost-effective way to improve health and quality of life.
How to cite this article:
Chaudhuri A, Goswami A, Ray M, Hazra SK, Bera S. Comparative study of effect of progressive muscle relaxation and walking on stress and cardiovascular profile in young adults of health sector.Saudi J Sports Med 2016;16:47-52
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Chaudhuri A, Goswami A, Ray M, Hazra SK, Bera S. Comparative study of effect of progressive muscle relaxation and walking on stress and cardiovascular profile in young adults of health sector. Saudi J Sports Med [serial online] 2016 [cited 2023 Mar 25 ];16:47-52
Available from: https://www.sjosm.org/text.asp?2016/16/1/47/167754 |
Full Text
Introduction
Stress has become a part and parcel of modern day life. Stress experiences often lead to various chronic health conditions such as hypertension and coronary heart disease.[1],[2],[3] Stress at work is an important risk factor for the emergence of metabolic syndrome. The plausible pathophysiology involves direct neuroendocrine effects and autonomic imbalance. Perceived stress has been reported higher in health-care professionals. In a developing country like India, in health sector, due to lack of trained manpower and poor infrastructure, one has to take extra burden of long duty hours and emergency duties day, night and evening schedules. More often only two persons have to continue duties for the whole week in one ward/section. Further due to inadequate rest and leisure time they cannot adequately prepare to take up competitive exams for postgraduate courses to improve their career. This also is an added stress. Lifestyle modifications may be a cost-effective way to improve health and quality of life.[4],[5],[6],[7],[8]
Physical activity is an important public health tool used in the treatment and prevention of various physical diseases, and in the treatment of some psychiatric diseases. Exercise is beneficial for mental health; it reduces anxiety, depression, and negative mood and improves self-esteem and cognitive functioning. Although the number of reports of the effects of physical activity on mental health is steadily increasing, these studies have not yet identified the mechanisms involved in the benefits and dangers to mental health associated with exercise.[2],[3],[4],[5]
Aerobic exercises have been proved to reduce anxiety and depression. These improvements in mood are proposed to be caused by an exercise-induced increase in blood circulation to the brain and by an influence on the hypothalamic-pituitary-adrenal (HPA) axis and thus, on the physiologic reactivity to stress. This physiologic influence is probably mediated by the communication of the HPA axis with several regions of the brain, including the limbic system, which controls motivation and mood; the amygdala, which generates fear in response to stress; and the hippocampus, which plays an important part in memory formation, as well as in mood and motivation.[2],[3],[4],[5]
The question of heterogeneity of effects of different approaches to stress management has been investigated in several quantitative meta-analyses. Progressive muscle relaxation (PMR) a widely used physical-based approach, has also been used for reducing psychological stress and blood pressure (BP).[9],[10] Muscle tension accompanies anxiety; one can reduce anxiety by learning how to relax the muscular tension. This technique is easy to learn and requires no constant guidance. Once the individual learns the correct way of doing PMR he/she can continue doing it to relieve the tension in the muscles.[9],[10],[11]
Hence, this study was conducted to compare effects of PMR and walking on stress and cardiovascular profile in young adults working in the health sector.
Materials and Methods
Approval from the Institutional Ethical Committee and informed consent of the patients was taken before conduction of this pilot project.
Inclusion criteria
Health-care professionals in the age group of 20–30 years were selected. The study subjects were doctors, nurses, physiotherapists, working in government hospitals in a rural area of Eastern India.
Exclusion criteria
Subjects suffering from chronic debilitating diseases such as cardiac arrhythmias, hypertension, diabetes, ischemic heart disease, retinopathy, nephropathy, or respiratory diseases, smokers, persons receiving any drug that may affect the autonomic reflexes were excluded. Subjects on treatment from psychiatry problem, pregnant women, puerperal mothers, sportswomen, yogis, subjects on regular meditation, and exercise regime were excluded. Women on oral contraceptives were not included. Subjects with a history of cardiovascular diseases, systemic illnesses, which involve respiratory system or alter vital parameters, respiratory tract infections within last 4 weeks were excluded. Smokers, grossly anemic subjects, subjects involved in professions that may affect respiratory functions and having dyspnea were not included.
Sampling was performed using multistage and random-cluster method. The first stage of sampling included a simple random sample to select five institutions with health-care professionals in the region. In the second stage of sampling, 30 subjects were randomly selected from each institution, who were then administered questionnaires.
On the first appointment, histories of the subjects were carefully recorded. Subjects were asked to tally a list of 43 life events based on a relative score. The stress level in the subjects was assessed according to the presumptive life event stress scale (PSLES).
Accordingly, they were categorized into no stress, less/moderate stress and severe stress. Score stress up to 40: No stress; 41–200 less/moderate stress; more than 200 severe stress. Finally, 120 subjects with scores above 200 were chosen for the study, as they had a higher risk of developing the illness.[10],[12]
The Perceived Stress Scale (PSS) of Sheldon Cohen, the most widely used psychological instrument for measuring the perception of stress, was used. It is a measure of the degree to which situations in one's life are appraised to be stressful. Items were designed to find how unpredictable, uncontrollable, and overloaded respondents find their lives. The scale also includes a number of direct queries about current levels of experienced stress. The questions in the PSS ask about feelings and thoughts during the last month. It comprises of 10 items, four of which are reverse-scored, measured on a 5-point scale from 0 to 4. PSS scores are obtained by reversing responses (e.g., 0 = 4, 1 = 3, 2 = 2, 3 = 1, and 4 = 0) to the four positively stated items (items 4, 5, 7, and 8) and then summing across all scale items. Total score ranges from 0 to 40.[10],[12],[13]
After clinical examinations were conducted and pretest instructions were given to avoid consumption of any drugs that may alter the autonomic function 48 h prior to the test, the subjects were advised to have a good restful sleep. The subjects were advised to have light dinner within 8 p.m. and go to bed early, and avoid stressful situations during the day before the tests were conducted. Relaxing bedtime routine, such as soaking in a hot bath or hot tub and then reading a book or listening to soothing music, was advised. They were asked to avoid caffeine (e.g., coffee, tea, and soft drinks, chocolate), nicotine (e.g., cigarettes, tobacco products), and alcohol close to bedtime.
On the day of the test, no cigarette, nicotine, coffee, or drugs were permitted. Fasting blood samples were drawn to exclude diabetes. Baseline anthropometric measurements, electrocardiogram, and lipid profile analysis were carried out. Body mass index (BMI), waist/hip ratio was recorded for each subject. The tests were performed at controlled room temperature in the morning between 10 a.m. and 11 a.m.
Subjects had light breakfast at least 3 h prior to testing and at least 24 h of abstinence from any form of alcohol, tobacco, tea, and coffee. It was ensured that they had not undergone any strenuous work or exercises 3 h prior to the tests. Resting pulse rate and BP were measured. Following tests were done.
Breath holding time
The subject was first explained and demonstrated the technique for breath holding and was asked to inhale maximally then hold breath till breaking point was reached, that is, the point when the subject could no longer hold his breath. The subject was motivated to maximize the breath- holding period. The time was noted in seconds by using a stopwatch, and the value was rounded off to integers. A minimum of three trials were given with rest period of 3 min between the trials, and the highest of three similar best performances was taken for statistical analysis.[12],[13]
Isometric handgrip test
Basal BP was measured. Then, the subject was asked to perform maximum grip of the handgrip dynamometer in sitting position with the dominant hand, and the maximum capacity was noted. After 5 min, the subject was asked to hold the grip with 30% of the maximum capacity for 5 min and the BP was recorded just after the release of the grip. The rise in diastolic BP was calculated and taken as the result of isometric handgrip test.[13]
Orthostatic tolerance test
After 5 min of rest in supine position, basal BP was recorded. Then the subject was asked to stand up, and the BP was recorded immediately. The difference of the systolic BPs between the one recorded during lying supine and in erect posture was calculated. The fall in systolic pressure was used as the result of orthostatic tolerance test (OTT).
The subjects were divided into two groups using an online randomizer. There was no difference in age, sex, PSS scores, vital parameters between the two groups. Group 1 subjects were given a training of PMR. Training involved tensing the specific muscle groups for 7–10 s, followed by releasing them (relaxing) for 15–20 s as per Jacobson's protocol.[10] Group 2 were advised to walk in the morning for 45 min daily, 5 days in a week and continue this exercise for 3 months. Subjects were followed up at regular intervals during this period. Ten subjects did not turn up for follow-up, so they were excluded. Therefore, the final sample consisted of 110 subjects (58 in Group 1 and 52 in Group 2).
Instruction in both active interventions included an introductory presentation and discussion, brief personal interview, personal instruction meeting, and three follow-up small group seminars. The instructional meetings lasted about 1.5 h each and took place over the course of 1-week. Thereafter, each stress-reduction group met for a 1.5-h session every month. Each of the instructors for the active interventions was a doctor. Participants of PMR were instructed to practice their respective techniques for 20 min twice daily (morning and evening) while seated comfortably with eyes closed. All participants were also requested not to reveal details of their program to individuals outside their treatment group.
After 3 months, all parameters were re-evaluated.
The computer software Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0., SPSS Inc., Chicago, IL, USA) was used for analysis of data. For all analysis, P < 0.05* was considered statistically significant and P < 0.01** as highly significant.
Results
A total of 150 subjects were asked to tally a list of 43 life events. Totally 120 with scores >200 were chosen for the study. Among them, 90 were males and 30 females. Ten subjects did not turn up for follow-up, so they were excluded. Therefore, the final sample consisted of 110 subjects (58 in Group 1 [45 males and 13 females] and 52 in Group 2 [40 males and 12 females]). Age in Group 1 was 24.45 ± 2.5 and Group 2 was 25.1 ± 2.3 with no significant difference in age between the two groups. PSLES in Group 1 was 520.09 ± 73.51 versus Group 2 was 524.8 ± 78.2 (P value = 0.62). There was no difference in all parameters between the two groups on initial examination [Table 1]. All parameters were significantly improved following practicing of PMR and exercise, except BMI, diastolic BP, low-density lipoprotein (LDL) cholesterol and OTT results [Table 2] and [Table 3]. There was no difference between the two groups after training program [Table 4].{Table 1}{Table 2}{Table 3}{Table 4}
Discussion
In the study, we compared effects of PMR and walking on stress levels and cardiovascular profile in young healthy adults. The results indicated a positive effect of both training program though there was no change in BMI, diastolic BP, LDL cholesterol, OTT.
W/H ratio was significantly decreased with a decrease in stress levels. Stress-related eating is associated with unhealthy eating and drinking habits and an increased risk of obesity among adults. Jääskeläinen et al. studied the prevalence of stress-related eating and its association with overweight, obesity, abdominal obesity, dietary, and other health behaviors at the age of 16. Furthermore, they examined whether stress-related eating is predicted by early-life factors including the birth size and maternal gestational health. It was noted Stress-related eating is highly prevalent among 16-year-old girls and is associated with obesity, as well as adverse dietary and other health behaviors among both genders.[8]
The prevalence of adolescent overweight is significant, almost 25% in some minorities, and often is associated with depressive symptoms. Psychological and psychosocial factors, as well as poor coping skills, have been correlated with unhealthy eating and obesity. The purpose of this study was to examine relationships among self-esteem, stress, social support, and coping; and to test a model of their effects on eating behavior and depressive mood in a sample of 102 high school students (87% minority). Results indicated that (a) stress and low self-esteem were related to avoidant coping and depressive mood, and that (b) low self-esteem and avoidant coping were related to unhealthy eating behavior. Results suggested that teaching adolescents skills to reduce stress, build self-esteem, and use more positive approaches to coping may prevent unhealthy eating and subsequent obesity, and lower risk of depressive symptoms.[7] We have also implemented stress management program in young healthy adults.
Schneider et al. tested the short-term efficacy and feasibility of two stress education approaches in the treatment of mild hypertension in older African Americans. Mental and physical stress-reduction approaches (transcendental meditation and PMR) were compared with a lifestyle modification education control program and with each other. PMR lowered systolic pressure by and diastolic pressure. Our results also indicated positive effects of PMR on systolic BP with no effect on diastolic. We had only taken young healthy adults in our study while in the above study was considered hypertensive in older African Americans this may be the cause of the difference in results.[11]
Patients suffering from schizophrenia who participated in a 3-month physical conditioning program showed improvements in weight control and reported increased fitness levels, exercise tolerance, reduced BP levels, increased perceived energy levels, and increased upper body and hand grip strength levels in studies by Fogarty et al. in 2004.[3] Thirty min of the exercise of moderate intensity, such as brisk walking for 3 days a week, was found sufficient for these health benefits. We also observed the positive impact of walking on stress and its adverse effects on the cardiovascular profile. Health benefits from regular exercise that should be emphasized and reinforced by every mental health professional to their patients advised by Sharma et al. in 2006.[4] included the following:
Improved sleep Increased interest in sex Better endurance Stress relief Improvement in mood Increased energy and stamina Reduced tiredness that can increase mental alertness Weight reduction Reduced cholesterol and improved cardiovascular fitness.
We had conducted studies to see effects of PMR.[9],[10],[12],[13] However, we had not included both genders while in the present study both males and females were included. In this study, many subjects who were advised to walk for 5 days in a week could only follow the exercise regime for 3 days in a week. This adds a limitation to the present study.
Conclusion
PMR and walking were equally effective in reducing stress and improving cardiovascular profile in young adults and may be used as a cost-effective way to improve health and quality of life.
Acknowledgments
We here by acknowledge the West Bengal university of health sciences for encouraging us to conduct the study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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