Perceived Effect Of Exercise On Blood Pressure Among People Living With Hypertension Attending Selected Hospital In Ilorin

Project and Seminar Material for Nursing (Science)

Perceived Effect Of Exercise On Blood Pressure Among People Living With Hypertension Attending Selected Hospital In Ilorin


Abstract


This study was carried out to examine the perceived effect of exercise on blood pressure among people living with hypertension attending selected hospital in Ilorin. The study was specifically set to assess the level of awareness about the non-pharmacological approach for control of blood pressure among people living with hypertension, determine whether exercises are integral component and cornerstone therapy for the primary control of hypertension, assess the effect of physical exercise on blood pressure management among people living with hypertension, and determine the extent at which hypertension patients participate in physical exercise. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprises people living with hypertension attending FMC in Ilorin. In determining the sample size, the researcher conveniently selected 147 respondents while 141 were received and validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables. The result of the findings reveals that exercises are integral component and cornerstone therapy for the primary control of hypertension. Furthermore, the result of the findings reveals that physical exercise has positive effect on blood pressure management among people living with hypertension. In regard to the findings, the study recommends that family physicians should routinely educate hypertensive patients on the benefit of regular physical exercise on their blood pressure control. To mention but few.


Table of Content


  • Title Page
  • Certification
  • Dedication
  • Acknowledgement
  • Table of Content
  • List of Tables
  • Abstract

Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organisations of the Study

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the Study
  • 3.3 Sample Size Determination
  • 3.4 Sample Size Selection Technique and Procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis
  • 3.8 Validity of the Study
  • 3.9 Reliability of the Study
  • 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One


Introduction

1.1 Background of the Study

Hypertension is the commonest non-communicable disease and the leading cause of cardiovascular disease in the world.1 It is an important and major public health challenge in both economically developing and developed countries and it affects approximately one billion people worldwide.1 Hypertension causes about 7.1 million death per year and 4.5 percent of the current global disease burden which translates to 64 million disability adjusted life years (DALYs).2

The burden of non-communicable diseases (NCDs) such as hypertension is increasing in epidemic proportion in Africa, in fact there is an emerging evidence to show that the pattern of diseases in sub-Saharan African is changing, with non-communicable diseases replacing the infectious communicable diseases and it has been documented as a threat to the health of the people and is a major contributor to the morbidity and mortality in the sub region.3

Hypertension or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated.4 This requires the heart to work harder than normal to circulate blood through the blood vessels. According to the Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VII), hypertension is defined as a systolic blood pressure (SBP) of 140 mmHg or greater and/or a diastolic blood pressure (DBP) of 90 mmHg or greater in subjects who are not taking antihypertensive medication.4 The global prevalence of hypertension is on the increase, in the year 2000, 972 million people had hypertension with a prevalence rate of 26.4%. 1 These are projected to increase to 1.54 billion individuals and a prevalence rate of 29.2% in 2025.1

Increasing urbanization typically leads to changing lifestyle factors which manifest in rapid epidemiological transitions with increased chronic disease burden in West Africa.5 The prevalence of hypertension is in line with the degree of urbanization in West Africa, with prevalence highest in Guinea (43.6%) and Burkina Faso (40.2%).6,7 The prevalence of hypertension in different parts of sub-Saharan African estimated in 2008 by Twagirrumukiza et al, put the prevalence at 18.4% for Nigeria.8 The increasing prevalence of hypertension is attributable to rapid transition of life style practices in developing countries including Nigeria, as well as increasing elderly population. 9

Hypertension increases with age, and the elderly comprise the fastest expanding age group globally, with the greatest increase occurring in developing countries.10 A study conducted by Asekun-Olarinmoye and colleague on the prevalence of hypertension in rural communities in South-West, Osun State Nigeria found that age 50 ‒ 69 years constitute 42.0% and the highest proportion of their hypertensives.11

The most common complications of hypertension are stroke, congestive heart failure and chronic kidney disease. A 5-year survey of medical admission in Enugu South-East Nigeria put hypertensive related complications as 46.1% and this accounted for more than two-third of cardiovascular system admission.12,13 Likewise a 3-year review of adult hypertensive admission in Benin-city, South-South, Nigeria, Ukoh reported that two-third of medical admission were as a result of high blood pressure and related morbidities.14

Hypertension can be managed pharmacologically using antihypertensive medications and non-pharmacologically with lifestyle modifications which have been shown to significantly reduce blood pressure in hypertensives of which physical activity is considered as one of the mainstay.12 Lifestyle measures for lowering blood pressure such as reducing salt intake, and alcohol consumption, increasing physical activity, controlling overweight and obesity, avoiding stress and others can potentially reduce requirements for antihypertensive medication and prevent high blood pressure from developing in non-hypertensive individuals.4

The controversies over the combined effect of exercise and weight reduction on blood pressure have been shown to help independently in a study conducted by Hagberg et al. 15 This was further corroborated by a comprehensive review by Collier and colleagues and they concluded that exercise training and dietary weight loss are independent, and that exercise can be effective in lowering blood pressure without concomitant reduction in body weight.16 Exercise as a lifestyle modification is beneficial to a wide variety of health conditions. Regular physical activity is the first treatment recommended to lower blood pressure and improve cardiovascular health both in the general population and those with hypertension.17 The benefits of control and treatment of high blood pressure are well-established from many previous studies, trials, reports, and guidelines in different populations, ethnic groups and nations. 4,18 A study on the effect of long-term physical exercise on blood pressure by Bell and colleagues revealed that moderate intensity physical exercise resulted in slight reduction of about 3.11 mmHg (SBP) and 2.99 mmHg in (DBP) from the base line to six weeks while at 12th weeks a reduction of 12.26 mmHg (SBP) and 8.41 mmHg (DBP) was found.19 Most exercise prescription for hypertensive patient include a duration of 30-60 minutes of aerobic exercise performed 3-5 times a week, several studies confirmed the result of low to moderate training being just as efficient in lowering blood pressure compared to high intensity cardiovascular exercise.18

In the seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VII), physical activity compares favorably with other recommended lifestyle changes in reducing resting blood pressure; a low to moderate intensity exercise of at least 30 minutes per day, 3-5 times in a week can reduce systolic blood pressure by 4-9mmHg.4 There are evidences that aerobic training helps to reduce blood pressure, for example in a meta-analysis of 54 clinical trials in hypertensive men and women findings included a reduction in SBP by an average of 3.8mmHg and 2.58mmHg for DBP. 18 The use of antihypertensive medication also necessitates physical activity guidelines, exercise is recommended as an adjunct to antihypertensive medication as there appears to be an additive effect of physical activity with most antihypertensive medication.18


1.2 Statement of Problem

Hypertension is such an important public health challenge in both economically developing and developed countries.1 Significant numbers of individuals with hypertension are unaware of their condition and, among those diagnosed hypertensives, treatment is frequently inadequate. Majority of the patients were only aware of the pharmacological management while only few numbers were aware of the non-pharmacological approach. Measures are required by physicians to improve patient education on the disease especially in the area of non-pharmacological approach.

Hypertension and other non-communicable diseases are currently responsible for at least 20 percent of all deaths in Nigeria and constitute up to 60 percent of the patient admitted into the medical wards of most tertiary hospital in Nigeria.20 Despite the availability of medical treatment, outcomes for the disease are very poor, prompting calls for better understanding of the knowledge of the disease.

Hypertension places an excessive financial burden on populations and health system, consuming scarce resources. 21 Population – based preventive approaches are thus central for the management of elevated blood pressure in developing countries where clinic-based care for complications is not a feasible option. There is also displacement of infectious diseases by non communicable diseases as a major cause of morbidity and mortality; as a community or country develops, this has been confirmed in most countries of the world including Nigeria.20,22,23 The rate of hypertension and its complications such as heart failure, stroke and chronic kidney disease are somehow decreasing in developed countries and it is increasing in developing countries possibly due to their degree of sedentary lifestyle. Most times hypertensive patients visit the clinics regularly and their blood pressure is not well controlled despite being on medication. The non pharmacological aspects of the management – the lifestyle modification are not well advocated as an adjunct to the prevention, treatment and control of hypertension of which physical exercise is an integral component. Physical Exercise remains a cornerstone therapy for the primary prevention, treatment and control of hypertension.18 Awareness is the key to such effective control; ignorance in this regard may be costly.

Optimal training, frequency, intensity, time and type of exercise need to be better defined to optimize its blood pressure lowering capacity. Engaging in physical activity offers one of the greatest opportunities to extend years of active independent life, reduce disability, and improve the quality of life.18 Unfortunately simply disseminating information about the health benefits of moderate physical activity does not appear to be sufficient to increase participation levels among sufferers.


1.3 Objective of the Study

The main objective of this study is to assess the perceived effect of exercise on blood pressure among people living with hypertension attending selected hospital in Ilorin, specifically the study intends to:

  1. Assess the level of awareness about the non-pharmacological approach for control of blood pressure among people living with hypertension.
  2. Determine whether exercises are integral component and cornerstone therapy for the primary control of hypertension.
  3. Assess the effect of physical exercise on blood pressure management among people living with hypertension.
  4. Determine the extent at which hypertension patients participate in physical exercise.

1.4 Research Question

  1. What is the level of awareness about the non-pharmacological approach for control of blood pressure among people living with hypertension?
  2. Are exercises integral component and cornerstone therapy for the primary control of hypertension?
  3. What is the effect of physical exercise on blood pressure management among people living with hypertension?
  4. What is the extent at which hypertension patients participate in physical exercise?

1.5 Research Hypothesis

  • Ho: There is no statistical significant relationship between physical exercise and blood pressure control.
  • Ha: There is a statistical significant relationship between physical exercise and blood pressure control.

1.6 Significance of the Study

Hypertension is a chronic disease associated with complications that are life threatening if not properly managed. The burden of the disease is enormous financially and overwhelming to the patients, relatives, health care provider and the health care system at large. The researcher observed that most hypertensive patients attending the clinic have little knowledge and understanding of the disease especially in the aspect of their treatment. Only few are aware of the importance of non-pharmacological treatment of hypertension that is lifestyle modification of which physical exercise is the mainstay, which can bring about the reduction in the burden, cost, side-effect of medications, morbidity and mortality associated with uncontrolled blood pressure. Only a few of our clients engage in physical exercise which is not constant and regular. The rise in number of hypertensive patients causes concern and calls for action in the prevention and treatment of the disease by implementing moderate regular aerobic physical exercise of at least 30 minutes, three times per week whenever possible which will eventually reduce their weight, financial burden and side effect of medications.

There is still paucity of data on the role of physical exercise on blood pressure control in Federal Medical Centre Ilorin and its environs. This study however may serve as a template and encourage more researchers to look into this area so as to reduce morbidity and mortality associated with the disease.

To the primary care Physicians who are the first contact with these patients, the findings from this study hopefully will serve as a basis for encouraging and persuading their patients to continually engage in physical exercise with a view to reducing the burden, cost, side-effect, morbidity and mortality associated with hypertension and other non-communicable diseases and in turn improve their quality of life.


1.7 Scope of the Study

This research work is centered on the perceived effect of exercise on blood pressure among people living with hypertension. The study will be carried out among people living with hypertension attending Federal Medical Center in Ilorin


1.8 Limitation of the Study

Like in every human endeavour, the researcher encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher simultaneously engaged in this study with other academic work. As a result, the amount of time spent on research will be reduced.

Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.


1.9 Definition of Terms

Hypertension:

Hypertension is defined as a systolic BP ≥ 140 mmHg and diastolic BP ≥ 90 mmHg or documented use of antihypertensive medications in a person previously diagnosed with hypertension.24

A patient was defined as having good BP if his or her BP at the end of the study was ˂ 140 mmHg and ˂ 90 mmHg by systolic and diastolic respectively, while poor BP was > 140 mmHg and > 90 mmHg by systolic and diastolic respectively.25

Physical Activity:

Physical activity (PA) was defined by WHO as any bodily movement produced by contraction of skeletal muscles that increases energy expenditure above resting levels and comprises routine daily tasks such as commuting, occupational tasks, or household activities, as well as purposeful health-enhancing movements/activities.26

Physical Exercise:

Physical exercise (PE) is a component of physical activity that is planned, structured, and repetitive with the intent of improving or maintaining health.

Aerobic activities: (Also called endurance activities) are physical activities in which people move their large muscles in a rhythmic manner for a sustained period. Running, brisk walking, bicycling, playing basketball, dancing, and swimming are examples of aerobic activities.

Walking:

(Also known as ambulation) is one of the main gaits of locomotion and is typically slower than running and other gaits. (To move along by putting one foot in front of the other)

Brisk Walking:

To walk at a steady pace that would seem faster than your typical walking pace and slower than a jogging pace. A great way to walk brisk would be to truly pump your arms as you walk.

Sedentary:

Activities that usually involve sitting or lying that have little additional movement and a low energy requirement.

Exercise Training:

Physical activity performed during leisure time with the primary purpose of improving or maintaining physical fitness, physical performance, or health.

Moderate Intensity Exercise:

An aerobic activity that is able to be conducted whilst maintaining a conversation uninterrupted. This exercise may last between 30 and 60 minutes. A person doing moderate intensity exercise can talk but not sing during activity.

Light Intensity Exercise:

An aerobic activity that does not cause a noticeable change in breathing rate. A person doing light intensity exercise can easily carry on a full conversation or even sing.

Vigorous Intensity Exercise:

An aerobic activity in which a conversation generally cannot be maintained uninterrupted. This exercise may last up to about 30 minutes. A person doing vigorous intensity exercise cannot say more than a few words without pausing for a breath.

High Intensity Exercise:

An intensity that generally cannot be sustained for longer than about 10 minutes.

Health-Enhancing Physical Activity:

An activity when added to baseline activity produces health benefits. Brisk walking, jumping rope, dancing, playing tennis or soccer, lifting weights, climbing on playground equipment at recess, and doing yoga are all examples of health enhancing physical activity.


1.10 Organizations of the Study

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.


Chapter Five


Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on the perceived effect of exercise on blood pressure among people living with hypertension attending selected hospital in Ilorin. The chapter consists of summary of the study, conclusions, and recommendations.


5.2 Summary of the Study

In this study, our focus was to examine the perceived effect of exercise on blood pressure among people living with hypertension attending selected hospital in Ilorin. The study is was specifically carried out to assess the level of awareness about the non-pharmacological approach for control of blood pressure among people living with hypertension, determine whether exercises are integral component and cornerstone therapy for the primary control of hypertension, assess the effect of physical exercise on blood pressure management among people living with hypertension, and determine the extent at which hypertension patients participate in physical exercise.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 141 responses were validated from the enrolled participants where all respondent were people living with hypertension attending FMC in Ilorin.


5.3 Conclusions

Based on the findings of this study, the researcher concluded that

  1. There is high level of awareness about the non-pharmacological approach for control of blood pressure among people living with hypertension.
  2. Exercises are integral component and cornerstone therapy for the primary control of hypertension.
  3. Physical exercise has positive effect on blood pressure management among people living with hypertension.
  4. The extent at which hypertension patients participate in physical exercise is low.

5.4 Recommendation

Based on the responses obtained, the researcher proffers the following recommendations:

  1. Family physicians should routinely educate hypertensive patients on the benefit of regular physical exercise on their blood pressure control.
  2. Further researches should be conducted on the effect of physical exercise on blood pressure control as a non-pharmacological management of hypertension to breach the gap between the pharmacological and non-pharmacological management of hypertension.
  3. Studies on the combined effect of lifestyle modifications on blood pressure control needed to be conducted in a bid to further breach the gap between pharmacological and non-pharmacological management of hypertension.

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