Effect of Short Term Isometric Handgrip Training on Blood Pressure among Hypertensive Patients in a Selected Community Area at Mangalore

Sruthi Thomas

Dr. M. V. Shetty College of Nursing, Mangalore, (RGUHS).

*Corresponding Author Email: sruthimenachery@gmail.com

ABSTRACT:

High blood pressure (BP) is a major public health problem in India and its prevalence is rapidly increasing among both urban and rural populations. In fact, hypertension is the most prevalent chronic disease in India. The prevalence of hypertension ranges from 20-40% in urban adults and 12-17% among rural adults. The number of people with hypertension is projected to increase from 118 million in 2000 to 214 million in 2025, with nearly equal numbers of men and women. A survey of 26,000 adults in South India showed a hypertension prevalence of 20% (men 23%and women 17%) but 67% of those with hypertension were unaware of their diagnosis.

The cost of drugs, drug interactions, and non-adherence with the drug regimen all contribute to current high rates of uncontrolled hypertension. Alternative, less expensive methods to reduce blood pressure that have lower risk of drug interactions and which may convey the benefits of long-term adherence are much needed. Blood pressure is a more common problem in India. Most of the middle age people are suffering from this .One of the best methods is to reduce blood pressure is isometric hand grip training .It is cost effective time saving and easy to practice. The study would keep the hypertensive to improve their quality of life.

Aim:

The aim of this study was to assess the effectiveness of isometric handgrip training on blood pressure among hypertensive patient in a selected community area at, Mangalore.

Objectives:

The objectives of the study are to:

a. assess the level of blood pressure among hypertensive patients by using sphygmomanometer of both experimental and control group.

b. evaluate the effect of short term isometric handgrip training on blood pressure among hypertensive patients of experimental in comparing with control group.

c. find the association between pre level blood pressure scores and selected demographic variables.

Methods:

Quantitative evaluative approach with a quasi-experimental repeated time series design was used in the study. Study was conducted in a selected community area at Mangalore. Forty samples were drawn using non probability purposive sampling technique. Pre-test was done by monitoring the selected pre-systolic and diastolic blood pressure and post-test was conducted by comparing the selected pre-systolic and diastolic blood pressure, before and after the administration of the isometric handgrip training.

RESULTS:

Majority of the subjects (45%) belonged to the group of 51-60 years of age, 27.5% belonged to 61 and above years of age, 22.5% belonged to41-50years of age and only 7.5% belonged to 31-40 years. Most of the subjects (55%) were males and remaining (45%) were females. Most of the subjects (60%) belonged to Hindu religion, 30% were Muslims, and remaining (10%) were Christians. Majority of the subjects (55%) were having no formal education, 37.5% were having primary education and only 7.5% were having high school education. Most of the subjects (52.5%) were unemployed, 42.5% were private employees, and 5% were government employees. Majority of the subjects (62.5%) were consuming mixed diet, remaining (37.5%) were vegetarians. Majority of the subjects (70%) were found to be married, 25% were unmarried and only 5% were widows and 5%were widowers. Majority of the subjects (55%) were with monthly income of below Rs. 10,000, 35% belonged to Rs. 10001-20000 and only 10% belonged to above Rs. 20000. Most of the subjects (55%) were from nuclear family, 45% belonged to joint family. Majority (42.5%) of the subjects in the group was diagnosed for 3-5 year. Subjects (30%) in the group were diagnosed for less than 3 years; 27.5% were diagnosed for 6 years and above. Majority (60%) were having family history of hypertension. Most of the subjects (40%) had no history of hypertension. Majority of were taking (72.5%) antihypertensive medicine and 27.5% were not taking antihypertensive medicine. Majority (72.5%) were not taking alternative therapies and 27.5% were taking alternative therapies.

KEYWORDS:

INTRODUCTION:

Good health is not only about not being ill, it is about being happy and feeling whole from a physical, mental and spiritual point of view. Being healthy is not anymore just about taking medicines when unwell, it means taking care of ourselves to prevent any illnesses and to change our attitude when we need to heal or get better after the illness. Taking care of our health today means doing a lot of things to feel good, from eating the right way to taking vitamins, from exercising to having a job we enjoy.

Good health can be hampered by a variety of factors. Chronic disease can result in loss of independence, years of disability, or death, and impose a considerable economic burden on family and health services. Today, chronic diseases are a major public health problem worldwide. In 2005, the World Health Organization (WHO) estimated that 61 per cent of all deaths—35 million—and 49 per cent of the global burden of disease were attributable to chronic diseases. By 2030, the proportion of total global deaths due to chronic diseases is expected to increase to 70 per cent and the global burden of disease to 56 per cent^1,2.

The World health statistics 2012 report, released on 16th May 2012 by WHO, Geneva, puts the spotlight on the growing problem of the non communicable diseases burden. According to the report, one in three adults worldwide, has raised blood pressure – a condition that causes around half of all deaths from stroke and heart disease.³According to WHO statistics(2002) in cardiovascular diseases prevention and control, it was estimated that 600 million people are affected with hypertension worldwide. WHO (2002) reports that hypertension caused 5 million premature deaths each year worldwide, causing 13% of global fatalities⁴.

The three leading risk factors for global disease burden in 2010 were high blood pressure, tobacco smoking, including second-hand smoking, and alcohol use, while in 1990 the leading risks were childhood underweight, household pollution from sold fuels, and tobacco smoking, including passive smoking⁵.

NEED FOR STUDY:

According to WHO Expert Committee (1996) and Joint National Committee Report on prevention detection and evaluation of high blood pressure recommends non pharmacological treatment as the first measure in control of hypertension. Hypertension or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the pressure in the arteries is elevated. As of 2000, nearly one billion people or 26% of the adult population of the world had hypertension. It was common in both developed (333 million) and developing (639 million) countries.

Cardiovascular diseases caused 2.3 million deaths in India in the year 1990; this is projected to double by the year 2020. Hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India. Hypertension prevalence is lower in rural Indian population although there has been a steady increase over time here as well. Recent studies have shown high prevalence of hypertension among urban adults. There is a strong correlation between changing lifestyle factors and increase in hypertension in India.

In recent years, isometric hand grip training has demonstrated the potential to be a promising anti-hypertensive option. Researches completed on this training modality have revealed significant reductions in systolic and diastolic blood pressure. Blood pressure is regulated by activity in the autonomic nervous system. The area of isometric hand grip training is only beginning to be uncovered. While numerous Isometric Hand Grip studies have been completed, this area still lacks a large scale, multi-centered investigation to determine the exact effectiveness of training as an adequate anti-hypertensive treatment.

Blood pressure more common problem in India. Most of the middle age people are suffering from this .One of the best method is to reduce blood pressure is isometric hand grip training .It is cost effective time saving and easy to practice. The study would keep the hypertensive to improve their quality of life. Hence the investigator was interested in this study.

Statement of the problem:

“Effect of short-term isometric handgrip training on blood pressure among hypertensive patients in a selected community area at Mangalore”.

Objectives of the study:

1. Assess the level of blood pressure among hypertensive patients by using sphygmomanometer of both experimental and control group.

2. Evaluate the effect of short-term isometric handgrip training on blood pressure among hypertensive patients experimental in comparing with control group.

3. find the association between pre level blood pressure scores and selected demographic variables.

Assumptions:

· Alteration in blood pressure increases by age.

· Hand gripper can be used as a tool of isometric hand grip training.

Delimitation of the study:

· Hypertensive patients who are living in selected community area at Mangalore.

· Forty hypertensive patients of the both gender.

Hypotheses:

· H1₁: There will be significant difference between the mean pre-test score and mean post-test score of short-term isometric handgrip exercise on blood pressure.

· H1₂: There will be a significant association between mean pre-test score and the selected demographic variables.

RESEARCH METHODOLOGY:

Research approach:

An evaluatory approach is used in this study to assess the effectiveness of isometric handgrip training on hypertensive patients.

Research design:

The research design adopted for this study is repeated treatment design (time series design, in quasi experimental design)..

Setting of the study:

The present study is conducted in Sasihithlu, a coastal area comes under Surathkal PHC, Mangalore.

Population:

The population of the study include patients with hypertension.

Sample:

Sample consisted of 40 patients with hypertension who satisfied the inclusion criteria, of which 20 belonged to the experimental group and 20 belonged to the control group. The sampling technique used for the study is non-probability purposive sampling.

Sampling technique:

In the present study, non-probability purposive sampling technique is used to select 40 hypertensive patient in a selected community area at Mangalore. Sample for the study will be selected by purposive sampling technique.

Data collection Method:

Sampling criteria:

Inclusion criteria for sampling:

· in the age group of 40 to -60 years and above.

· both male and female with Blood Pressure ≥140/90 mm of Hg.

· Willing to participate in the study.

· Who are available during the period of data collection.

· Hypertensive patient who are taking antihypertensive medicine.

· Patient who can understand Kannada or English or Malayalam.

Exclusion criteria for samplings:

· diagnosed with renal disorders, brain pathology and congestive heart failure.

· Having peripheral occlusive vascular disease.

Description of the tool:

Part I: Description of demographic characteristics of hypertensive subjects.

Part II: Blood pressure level among hypertensive subjects in control and experimental group

Part III: Effectiveness of isometric hand grip training among experimental group in comparing with control group.

Section A: Comparison of pre-test and post-test blood pressure level of subjects in the experimental group

Section B: Comparison of different observation among experimental and control group.

Part IV: Association between effectiveness of isometric handgrip training on maintaining the blood pressure level with selected demographic variables.

RESULT:

Part I: Description of demographic characteristics of hypertensive subjects

This part deals with distribution of participants according to their demographic characteristics. Data was analysed using descriptive statistics and was summarised in terms of percentage.

Table 1: Frequency and percentage distribution of subject based on age n=40

Age (in years)	Experimental group		Control group
Age (in years)	F	%	f	%
a. 31-40	1	5	2	10
b. 41-50	5	25	4	20
c. 51-60	9	45	9	45
d. 61 and above	6	30	5	25

Table 1 shows that most of the subjects (45% in the experimental group and 45% in the control group) belonged to the age group 51-60 years; 25% in the experimental group and 20 % in the control group belonged to the age group of 41-50 years. The groups were comparable with respect to age.

The distribution of the subjects in the experimental and control group based on gender is given in Figure 3.

Figure 3 shows that 55% of the subjects in the experimental group and 55% of the control group were males.45% of the experimental group and 45% of the control groups were females. The groups were comparable with respect to gender.

Figure 3: Frequency and percentage distribution of subject based on gender

Table 2: Frequency and percentage Distribution of subjects based on religion n=40

Religion	Experimental group		Control group
Religion	f	%	f	%
a. Hindu	11	55	13	65
b. Muslim	6	30	6	30
c. Christian	3	15	1	5

Table 2 shows that 55% in the experimental group and 65% in the control group were Hindus. Muslims constituted 30% in the experimental group and 30% in the control group. Christians constituted 15% in the experimental group and5% in the control group.

Table 3: Frequency and percentage distribution of subjects based on educational status N=40

Educational status	Experimental group		Control group
Educational status	f	%	f	%
a. No formal education	15	65	9	45
b. Primary school	6	30	9	45
c. High school	1	5	2	10
d. Higher secondary and above	0	0	0	0

Table 3 shows that 65% of the subjects in the experimental group and 45% of subjects in the control group had non-formal education. Thirty percent of the experimental group and 45% of the control group had primary education.

The distribution of the subjects in the experimental and control group based on the occupation is given in figure 4.

Figure 4 shows that a larger percentage of the subjects (45% in the experimental group and 60% in the control group) were unemployed.

Table 4: Frequency and percentage distribution of subjects based on food habits N=40

Food habits	Experimental group		Control group
Food habits	f	%	f	%
a. Vegetarian	5	25	10	50
b. Mixed	15	75	10	50

Table 4 shows that most of the subjects in the experimental group and half of the subjects in control group had a mixed diet pattern. Hence the groups were comparable with respect to their dietary pattern.

Table 5: Frequency and percentage distribution of subjects based on marital status N=40

Marital status	Experimental group		Control group
Marital status	f	%	f	%
a. Married	16	80	12	60
b. Single	2	10	6	30
c. Widow	1	5	1	5
d. Widower	1	5	1	5

Table 6 shows that most of the subjects in the subject in the experimental and control group had married.

Table 7 shows that most of the subjects in experimental and control group have income below Rs. 10,000 and 35% of experimental group and 40% of control group have monthly income between Rs. 10,001-20,000.

Table 6: Frequency and percentage distribution of subjects based on monthly income N=40

Monthly income	Experimental group		Control group
Monthly income	f	%	f	%
a. Below Rs. 10,000	11	55	11	55
b. Rs. 10,001-20,000	7	35	8	40
c. Rs. 20,001 and above	2	10	1	5

Table 7: Frequency and percentage distribution of subjects based on type of family N=40

Type of family	Experimental group		Control group
Type of family	f	%	f	%
a. Nuclear	11	55	13	65
b. Joint	9	45	7	35

Table 7 shows that 55% of the subjects in the experimental group and 65% in control group belongs to nuclear family. 45% of the experimental group and 35% of the control group are belongs to joint family.

Table 8: Frequency and percentage Distribution of subject based on duration of treatment of hypertension N=40

Duration of treatment with hypertension	Experimental group		Control group
Duration of treatment with hypertension	f	%	f	%
a. Less than 3 years	4	20	8	40
b. 3-5 years	10	50	7	35
c. 6 and above years	6	30	5	25

Table 8 shows that 20% of the subjects in the experimental group were diagnosed for less than 3 years. Most of the subjects in experimental (50%) and control group (35%) were on diagnosed with hypertension for 3-5 years.

The distribution of the subjects in the experimental and control group based on the family history of hypertension is given in Figure 5.

Figure 5 shows that majority of the subjects (65% of the experimental group and 70% of the control group) had family history of hypertension. Twenty-five percent of the subjects in the experimental and 30% control group not had family history of hypertension

The distribution of the subjects in the experimental and control group based on using alternative therapy of hypertension is given in Figure 6.

Figure 6: Distribution of subjects based on using alternative therapy of hypertension

Figure 6 shows that 85% of the subjects in the experimental group and 60% of control group are not using any alternative therapy. The groups were comparable with respect to the alternative therapy adopted.

Part II: Pre-intervention blood presure level among hypertensive subjects of experimental and control group

Objective 1: Assess the level of blood pressure among hypertensive patients by using sphygmomanometer.

Table 9: Mean, MD, mean difference and S.D of systolic blood pressure level among hypertensive clients of experimental and control group N=40

Group	Mean	Median	Mean difference	SD
Experimental	152	150	4	7.67
Control	157	160	4	4.44

The data presented in the Table 9, shows the Mean, MD, Mean difference and SD of systolic blood pressure level among hypertensive clients in experimental and control group. The mean systolic blood pressure level of control group (157 mm of Hg) was slightly higher than experimental group (152 mg/dl). The mean difference is 4. It shows that there was minimum difference between the mean blood pressure level in both experimental and control group.

Table 10: Mean, MD, mean difference and SD of diastolic blood pressure level among hypertensive clients of experimental and control group N=40

Group	Mean	Median	Mean difference	SD
Experimental	96	100	7	5.02
Control	103	100	7	4.70

The data presented in Table 10 shows the Mean, MD, Mean difference and SD of diastolic blood pressure level among hypertensive clients in experimental and control group. The mean systolic blood pressure level of control group (96 mm of Hg) was slightly higher than experimental group (103 mg/dl). The mean difference is 7. It shows that there was minimum difference between the mean blood pressure level in both experimental and control group.

Part III: Effectiveness of isometric hand grip training among experimental group in comparing with control group.

This section deals with the effectiveness of the isometric handgrip training in maintaining blood pressure level among subjects from experimental group. To test the significance of difference among different observation for the effectiveness of isometric hand grip training maintaining blood pressure level, single factor analysis of variance (ANOVA) was used for statistical analysis. Null hypothesis was computed to test the significance.

Objective 2: To evaluate the effect of short-term isometric handgrip training on blood pressure among hypertensive patients both experimental and control group

H₀₁: There will be significant difference between the pre-intervention and post intervention blood pressure level of clients with hypertension in experimental group.

Part A: Comparison of pre-test and post- test Systolic blood pressure levels of subjects

Table 11: Mean, SD and ‘F’ value of Systolic blood pressure levels of subjects with hypertension N=20

Treatment days

Systolic blood pressure

Mean

Before

After

Pre-test

5^th day

10^th day

15^th day

152

141

125

7.67

8.75

5.10

54.90*

Table value of F: 2.74, df 3, 76 at p< 0.05 *Significant

Data presented in Table 11 deals with the mean, SD and single factor analysis of variance (ANOVA) of systolic blood pressure level. The post-test values of systolic blood pressure levels on 5^th day to 15^th days reveals that reduction in mean BP value from 152 to 125, shows the effectiveness of isometric hand grip training and also the calculated F value 54.90 was greater than the table value (2.74) at 0.05 level of significance. Hence in this area the null hypothesis was rejected and research hypothesis was accepted. Thus it can be inferred that isometric handgrip training was effective in regulation of systolic blood pressure levels of clients with hypertension.

Table 12: Mean, SD and ‘F’ value of Diastolic blood pressure levels of subjects with hypertension N=20

Treatment days

Diastolic blood pressure

Mean

Before

After

Pre-test

5^th day

10^th day

15^th day

5.02

4.70

4.73

4.89

32.542*

Table value of F: 2.74, df 3, 76 at p< 0.05 *Significant

Data presented in Table 12 deals with the Mean, S.D and single factor analysis of variance (ANOVA) of diastolic blood pressure level. The post-test values of diastolic blood pressure levels on 5^th day to 15^th days reveals that reduction in mean BP value from 97 to 93, which shows the effectiveness of isometric hand grip training and also the calculated F value 32.542 is greater than the table value (2.74) at 0.05 level of significance. Hence in this area the null hypothesis was rejected and research hypothesis was accepted. Thus it could be inferred that isometric handgrip training was effective in regulation of diastolic blood pressure level of clients with hypertension.

Figure 7: Line diagram showing pre-test and post-test values of Systolic and Diastolic blood pressure

Data presented in Table 13 deals with mean difference and ‘P’ value of the effectiveness of intervention on different observations of systolic BP of clients with hypertension. To find out the day on which isometric handgrip training started providing effect, Post Hoc test was used to compute the multiple observations. It was found that on 5^th day p value (1.000) was significant in compare with table value of 0.05. The more effect was found on 10^th day (0.002) and on 15^th day (0.000). It shows that continuously performing isometric handgrip training helps in maintaining systolic blood pressure of client with hypertension.

Table 13: Multiple comparison of Mean Difference and ‘P’ value of observations of Systolic BP on different days of subjects

N=20

Observation

(I)

Comparison (J)

Mean difference (I-J)

p-value

Mean pre-test

Post-test day 5

Post-test day 10

Post-test day 15

Post-test day 5

Post-test day 10

Post-test day 15

Mean pre-test

Post-test day 10

Post-test day 15

Mean pre-test

Post-test day 5

Post-test day 15

Mean pre-test

Post-test day 5

Post-test day 10

0.00000

10.00000

27.00000

0.00000

10.50000

27.00000

-10.50000

16.50000

-27.00000

-16.50000

1.000*

.002*

.000*

1.000*

.002*

.000*

.002*

.000*

* Significant

Table 14: Multiple comparison of Mean Difference and ‘P’ value of observations of Diastolic BP on different days of subjects N=20

Observation (I)

Comparison (J)

Mean difference (I-J)

p-value

Mean pre-test

Post-test day 5

Post-test day 10

Post-test day 15

Post-test day 5

Post-test day 10

Post-test day 15

Mean pre-test

Post-test day 10

Post-test day 15

Mean pre-test

Post-test day 5

Post-test day 15

Mean pre-test

Post-test day 5

Post-test day 10

-1.00000

3.00000

12.50000

1.00000

4.00000

13.50000

-3.00000

-4.00000

3.66667

-12.50000

-13.50000

-9.50000

.986

.294*

.000*

.986

.060*

.000*

.294*

.060*

.000*

* Significant

Data presented in Table 14 deals with Mean Difference and ‘P’ value of the effectiveness of intervention on different observations of diastolic BP of clients with hypertension. To find out the day on which isometric handgrip training started providing effect, Post Hoc test was used to compute the multiple observations. It was found that the ‘p’ value on 5^th day (0.986) was significant when compared with table value of 0.05. The more effective was found on 10^th day (0.294) and on 15^th day (0.000). It shows that continuously performing isometric handgrip training helps in maintaining diastolic blood pressure level of client with hypertension.

Table 15: Mean, standard deviation, mean difference and ‘t’ value of different observations on systolic blood pressure level in experimental and control group is calculated N₁=20, N₂=20

Observation	Group	Mean	Mean difference	Standard deviation	Independent t value
Pre-test	Experimental	152.0	5.5	7.67	2.77
	Control	157.5		4.44
Post-test 5^th day	Experimental	152.0	6.0	7.67	3.08
	Control	158.0		4.10
Post-test 10^th day	Experimental	141.5	7.0	8.75	2.30
	Control	148.5		10.39
Post-test 15^th day	Experimental	125.0	17.5	5.12	8.80
	Control	142.5		7.16

Table value, t₃₈=2.013 at p<0.05 *Significant

Table 16: Mean, standard deviation, mean difference and ‘t’ value of different observations on diastolic blood pressure level in experimental and control group is calculated N₁=20, N₂=20

Observation	Group	Mean	Mean difference	Standard deviation	Independent t value
Pre-test	Experimental	96.0	7.0	5.02	4.5*
	Control	103.0		4.70
Post-test 5^th day	Experimental	97.0	4.0	4.70	2.40*
	Control	101.0		5.52
Post-test 10^th day	Experimental	93.0	4.5	4.70	3.11*
	Control	97.5		4.44
Post-test 15^th day	Experimental	83.5	9.5	4.89	6.26*
	Control	93.0		4.70

Table value, t₃₈=2.013 at p<0.05 *Significant

Table 17: Post-test mean, mean difference, standard deviation, independent t test value of systolic blood pressure among experimental and control group N₁₌20, N₂₌20

Group	Mean post-test	Mean difference	Standard deviation	Independent t test
Control	149.0	9.15	7.63	2.15
Experimental	139.5	9.15	8.03	2.15

Table 18: Post-test mean, mean difference, standard deviation, independent t test value of diastolic blood pressure among experimental and control group N₁₌20, N₂₌20

Group	Mean post-test	Mean difference	Standard deviation	Independent t test
Control	97.16	5.99	7.43	2.65*
Experimental	91.16	5.99	9.16	2.65*

Table 19: Association of Systolic blood pressure level with baseline variables N=40

Sl. No. Baseline variables

c²value

Inference

1. Age

2. Gender

3. Religion

4. Educational status

5. Occupational status

6. Food habits

7. Marital status

8. Monthly income

9. Type of family

10. Since how long you have been diagnosed with hypertension

11. Do you have family history of hypertension

12. Are you taking any antihypertensive medication

13. Have you used /using any alternative therapy

2.880

0.606

2.998

2.351

1.551

0.014

0.040

1.186

1.381

0.506

0.156

1.338

0.084

NS=Non significant

Table 20: Association of Diastolic blood pressure levels with baseline variables N=40

Sl.
No. Baseline variables

c²value

Inference

1. Age

2. Gender

3. Religion

4. Educational status

5. Occupational status

6. Food habits

7. Marital status

8. Monthly income

9. Type of family

10. Since how long you have been diagnosed with hypertension

11. Do you have family history of hypertension

12. Are you taking any antihypertensive medication

13. Have you used /using any alternative therapy

3.298

0.609

0.358

0.711

1.355

0.085

0.147

5.025

2.973

1.677

3.723

0.189

1.161

NS=Non significant c²₁=3.84, c²₂=5.99

The data presented in Table 18 shows that the ‘t’ value computed between the post-test of experimental group and post-test of control group of diastolic blood pressure level was statistically significant at p<0.05 and df=38. The calculated ‘t’ value (t=2.65) was greater than the table value (t₃₈=2.03). This indicates that the isometric handgrip training was effective in reducing diastolic blood pressure level among hypertensive patients. Hence the null hypothesis was rejected and research hypothesis was accepted. It can be inferred that isometric handgrip training has a significant effect on reducing blood pressure level among hypertensive subjects.

Part IV: Association between effectiveness of isometric handgrip training on maintaining the blood pressure level with selected demographic variables

Objective 3: To find out the association between existing blood pressure and baseline variables.

H₀₂: There will be no significant association of blood pressure level with baseline variables.

The data presented in Table 19 shows that there was no association between the blood pressure level and baseline variables like age, gender, religion, education, occupation, food habits, marital status, monthly income, type of family, duration of diagnosis, family history of hypertension, history of antihypertensive medicine, usage of alternative therapy and the values are 2.880, 0.606, 2.998, 2.351, 1.551, 0.014, 0.040, 1.186, 1.381, 0.506, 0.156, 1.338, 0.084 and 0.288, respectively. Hence the null hypothesis was accepted and stating that there will be no association between baseline variables with systolic blood pressure levels.

The data presented in Table 20 shows that there was no association between the blood pressure level and demographic variables like age, gender, religion, education, occupation, food habits, marital status, monthly income, type of family duration of diagnosis, family history of hypertension, history of antihypertensive medicine, usage of alternative therapy and values are 3.298, 0.609, 0.358, 0.711, 1.355, 0.085, 0.147, 5.025, 2.973, 1.677, 3.723, 0.189, and 1.161, respectively. Hence the null hypothesis was accepted and stating that there will be no association between baseline variables with diastolic blood pressure levels.

DISCUSSION:

The present study was aimed to assess the effect of isometric hand grip exercise on blood pressure among patients with hypertension under the rural community area Sasihitlu, Surathkal PHC

The findings of the study have been discussed in terms of objectives and hypotheses. In the present study, data were collected from 40 patients (20 in the experimental group and 20 in the control group)who under the rural community area Sasihitlu , Surathkal PHC . The results revealed that handgrip exercise performed for a period of 15 days is effective in reducing the systolic blood pressure and the diastolic blood pressure.

In the present study, the findings revealed that most (45%) of the subjects were belongs to the group of 51-60 years of age. The results are supported by the findings of an experimental study by Dr. Oz Show on isometric exercise Can Lower Blood that the majority (52.34%) of the subjects were in age above 50 years.⁶

The present study findings revealed that majority (55%) of the subjects in the study were males. The results are supported by the findings of a meta-analysis study conducted on eighty-one men and women (42 exercise and 39 control) from three of 287 reviewed studies were pooled for analysis. Using random-effects models, statistically significant exercise minus control group reductions of approximately 10% were observed for both resting SBP and DBP(SBP:Xd,-13.4mmHg;95%BCI, -15.3 to -11.0 mmHg and DBP: X, -7.8 mmHg; 95% BCI, -16.5 to -3.0 mmHg). Results were also statistically significant when fixed-effects models were used (SBP: X , -13.8 mmHg; 95% BCI, -15.3 to -11.0 mmHg and DBP: X , -6.1 mmHg; 95% BCI, -16.5 to -3.2 mmHg).

Present study findings revealed that majority (55%) of the subjects were not having no formal education. The study results are supported by the findings of an experimental study conducted by M. Hagins, R. States. On “Effectiveness of isometric handgrip training for hypertension: Systematic review and meta-Analysis” found that majority (47%) of the subjects were having no formal education.⁷

The present study findings revealed that most (52.5%) of the subjects were unemployed. The study results are supported by the findings of a prospective study conducted by McCaffrey, Ruknui, Hatthakit, and Kasetsomboon, on the effects of isometric handgripexercise on hypertension showed that 45.75% of the subjects were unemployed.⁸

In this study, most (62.5%) of the subjects were consuming mixed diet. In the present study findings revealed that majority (55%) of the subjects were with monthly income below Rs. 10000.

In the experimental group the mean post-test systolic blood pressure level score (139.5 mmHg) of the subjects is significantly lower than the mean pre-test systolic blood pressure level score (152 mmHg) and mean post-test diastolic blood pressure score (91.16 mmHg) of the subjects is lower than the mean pre-test diastolic blood pressure score (96). The ‘F’ value computed for the repeated measure of systolic blood pressure level (F=58.90) was greater than the tabled F ratio (F_3,76=2.74) at 0.05 level of significance and of diastolic blood pressure level (F=32.54) was greater than the tabled F ratio (F_3,74=2.74) at 0.05 level of significance. The calculated ‘t’ value of systolic BP (t=2.15) was more than the table value (t(38)=2.03) at 0.05 level of significance and diastolic BP (t=2.65)was more than the table value (t(38)=2.03) at 0.05 level of significance. This indicated that isometric handgrip training was effective in reducing the blood pressure level among clients with hypertension.

As supporting evidence to the present study, an expert research panel from American Heart Association published the results of their study on April 2013.They found out that the patients who performed handgrip exercise for 2 weeks demonstrated a 10% drop in both systolic and diastolic blood pressure.⁹

Likewise another study by Gurpeet K. Dhillon concluded that handgrip devices are effective in lowering systolic and diastolic blood pressure of participants over a 6 week period¹⁰.Similarly studies by Millar and Levy revealed that isometric handgrip exercise performed for 8 weeks decreased systolic and diastolic blood pressure.¹¹A meta analysis of the controlled trials by Owen A, Wiles in 2010 also showed that handgrip exercises for <1 hour/week reduced systolic and diastolic blood pressure.

A recent study by G. R. Devereux at Canterbury Christ Church University also showed that 4 weeks of bilateral leg isometric exercise is sufficient to result in significantly reduced systolic blood pressure by 5mm Hg and Diastolic blood pressure by 3 mm Hg.

A few studies by Millar, Philip J and Taylor, McCartney and studies at Harvard University demonstrated that handgrip exercise is capable of causing reductions in systolic blood pressure, but not in diastolic blood pressure.

A handful of studies have looked at how the handgrip exercises influences blood pressure. Though the studies were small and short, the results have been remarkably similar. In most of the studies, participant’s systolic blood pressure dropped at an average of 14 points. The exercise had little effect on diastolic blood pressure.¹²

Similar to the findings in most of the studies related to the handgrip exercise’s influence on blood pressure, the present study also revealed significant difference in the systolic and diastolic blood pressure after a period of 4 weeks. However, the effect is more pronounced on systolic blood pressure. The advantages of the findings are numerous because 70% of the people cannot control high blood pressure, according to a survey by Centre for Disease Control and Prevention.¹²So isometric handgrip exercise may serve as an effective and simple method of controlling hypertension, and is a new means of hope for the hypertensive patients when the conventional drugs do not work for them or when they cannot live with the side effects of the drugs, when they do not have adequate time and energy to perform regular aerobic exercises or when they don’t have the money to spend on an ongoing basis.

Implication for nursing practice:

• The nurse can educate clients approaching for the treatment of hypertension regarding the importance of isometric handgrip training.

• The community health nurse must implement information education and communication (IEC) to create awareness to the community on the benefits of isometric hand grip training.

Implication for nursing education:

• Nursing education should emphasize more on preparing the nurses to impart current changes in health information and to update the knowledge in all fields.

Implication for Nursing administration:

· Nurse should design formal teaching programme on hypertension and its prevention using pharmacological and various non-pharmacological methods in reducing blood pressure levels in the community

Implication for Nursing research:

• Hypertension can also cause serious health complications such as heart disease, kidney failure, stroke, and even blindness.

• There is a good scope for the nurses to conduct research in the areas of non-pharmacological management which is free from side effects, which also improves the physical and mental health of the subjects.

• The results of the study are motivating to those who are interested in conducting similar studies in the area in order to identify the problems and the different modes of management.

• Isometric handgrip training has shown to be effective in maintaining blood pressure level.

• Further studies can be conducted on isometric handgrip training to see its effect on diabetes mellitus, cardiac problems, asthma etc. and even research can be conducted to assess its effectiveness on other disease conditions.

Limitations of the study:

• The study was conducted in a selected coastal area only.

• The sample size is limited to 40. Hence generalization of the study was not possible.

• Isometric handgrip training was observed only for 15 days.

RECOMMENDATIONS:

• A study can be replicated in urban areas.

• A comparative study can be conducted to assess blood pressure level of hypertensive clients in rural and urban areas.

• A similar study can be conducted in large group of clients with hypertension.

• A longer period of intervention can be conducted for more reliable and effective outcomes

REFERENCE:

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2. World Health Organization. Geneva Projections of mortality and burden of disease to 2030. [Internet] 2009 Mar [Cited 2009 Aug].

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4. Sujatha T. Educational intervention on blood pressure and hypertension. Nightingale Nursing Times 2013 Apr; 9(1):84-9.

5. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study. Lancet 2012 Dec 15;380(9859):2224-60.

6. Show O. Study shows yoga can lower blood pressure. [online]. Available from: URL:http://blog.doctoroz.com/in-the-news/study-shows-yoga-can-lower-blood-pressure

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8. Hagins M, States R. Effectiveness of yoga for hypertension: systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine 2013; 2013:649836.

9. American Heart Association. Alternative therapies may help lower blood pressure. Science Daily. [cited 2013 April 22]. Available from: URL:http://www.saga.co.uk/health/news/2013/april/lower-blood-pressure-with-simple-exercises-416.aspx

10. Mortimer J, Mckune AJ. Effect of short-term isometric handgrip training on blood pressure in middle-aged females. Cardiovascular Journal of Africa 2011 Sep; 22(5).

11. MacDougall JD, Tuxen D, Dale D, Moroz J, Sutton J. Arterial blood pressure response to heavy resistance exercise. Journal of Applied Physiology 1995; 58:785-90.

12. Taylor AC, McCartney N, Kamath MV, Wiley RL. Isometric training lowers resting blood pressure and modulates autonomic control. Med Sci Sports Exerc 2003 Feb; 35(2):251-6.

Received on 30.12.2015 Modified on 21.02.2016

Int. J. Nur. Edu. and Research.2016; 4(2):157-168.

DOI: 10.5958/2454-2660.2016.00033.8