*Corresponding Author E-mail: manjula_siva@yahoo.co.in
ABSTRACT:
Alternate nostril breathing, one of the yogic techniques can produce different physiological changes in healthy individuals. The present study was undertaken to assess the effect of Alternate nostril breathing on Blood pressure among Patients with Hypertension. The objectives of the study were to assess the level of Blood pressure among Patients with Hypertension in the experimental and the control group, determine the effect of Alternate nostril breathing on Blood pressure among patients with Hypertension in the experimental group and find the association between the pre- test level of Blood pressure among Patients with Hypertension and selected socio- personal variables. Quantitative evaluative approach with quasi experimental non- equivalent pre-test post-test control group design was adopted for the study. Purposive sampling technique was used and 60 Hypertensive patients (30 in the experimental and 30 in the control group) were taken from Kannur Medical College Hospital. The subjects in the experimental group performed the Alternate nostril breathing for three weeks and no intervention to the control group. Systolic and Diastolic Blood pressure were recorded before and after the intervention. The results revealed that the mean post-test Blood pressure was lower than the mean pre-test Blood pressure in the experimental group (t=13.21, t=2.71, p<0.05 Systolic and Diastolic Blood pressure respectively). When comparing the effectiveness of Alternate nostril breathing in the experimental group with the control group, it was found that the significant difference in Systolic Blood pressure (t= 2.57, p<0.05) and also there was a significant association between Blood pressure and age, education and exercise. The finding of the study interpreted that the practice of Alternate nostril breathing (Nadi shodhana) is effective in reducing Blood pressure among patients with Hypertension. Considering the facts this technique can be suggested as a regular practice for combating with burden of Hypertension in the community with proper monitoring.
KEYWORDS: Effect, Alternate nostril breathing, Blood pressure, Wellbeing.
INTRODUCTION:
The body is your temple. Keep it pure and clean for the soul to reside in.
Health is the general condition of a person in all aspects. It is also a level of functional and/or metabolic efficiency of an organism, often implicitly human. World Health Organization (WHO) in 1948 defined Health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity" Some would consider it idealistic and nonrealistic, as this definition categorizes majority of people as unhealthy.1 Due to globalization and urbanization, trends of diseases are growing rapidly and more number of individuals are exposed to various diseases. Individuals in the developing world have the double whammy of increased chronic disease prevalence combined with the persistently high rates of infectious diseases, leading to exceedingly high morbidity and mortality2.
Hypertension is the commonest cardiovascular disorder, posing a major public health challenge to population in socioeconomic and epidemiological transition. It is one of the major risk factor for cardiovascular mortality, which accounts for 20-50% of all deaths.3 Neither a high nor a low Blood pressure is desirable, a balance is essential in the body. While healthy dietary habits contribute to maintaining the balance, we can’t ignore the role played by the mind either. So to harmonize the body, yoga is the best. Yogasanas involves breathing consciously and deeply, while synchronizing the body movements. They can help to control Blood pressure naturally, primarily by relieving stress. Yogasanas can soothe the nerves and help to slow down an abnormal heart rate. It helps in increasing immunity and reducing incidences of heart problems like heart attacks and strokes by regulating sleep habits and patterns that alleviates stress and thus Hypertension. Also by way of giving positive energy to the body and mind, it makes happier and hopeful life, in the long run this helps to lower high Blood pressure.4
Non-Communicable Diseases are now the leading causes of death worldwide. Representing a growing threat to national and global health as well as social and economic development, these diseases are increasingly recognized by governments, non-government organizations and the scientific community as a chronic global epidemic and their burden is expected to double by 2030.5 Data from the Registrar General of India, World Health Organization and Global Burden of Disease Study have reported that cardio vascular diseases are the most important causes of death and disability. Intensive Public Health effort is required to increase its awareness, treatment and control. UN sustainable development goals highlight the importance of high rates of Hypertension control for achieving target of 1/3 reduction in non- communicable disease mortality by 2030. It is estimated that better Hypertension control can prevent 400-500,000 premature deaths in Indi.6
Hypertension cannot be eliminated because there are no vaccines to prevent the development of Hypertension, but, its incidence can be decreased by reducing the risk factors for its development, which include obesity, high dietary intake of fat and sodium and low intake of potassium, physical inactivity, smoking, and excessive alcohol intake. For established Hypertension, efforts are to be directed to control Blood pressure by lifestyle modification.7
Many practitioners like orthodox, complimentary therapy recommended that, patients with Hypertension needs relaxation techniques. In the relaxed state adrenaline levels are lowered, which reduces muscle tension, reduces regular diaphragmatic breathing and promotes mental calm. The body uses less energy than usual and there is less work for the heart, lungs and brain. Regular relaxation exercises have been shown to lower Blood pressure, but this is used mainly as an adjunct to treatment.8 Breathing training is widely used as an aid in reducing anxiety state. Several other applications also show the evidence that normalizing the breathing patterns may offer help in some cases of essential Hypertension, chest disorder.9
Nurses, being an integral part of healthcare provider system, have the responsibility to explore the lifestyle associated risk factors of Hypertension, to plan and implement teaching strategies and other form of interventions for the community and thereby to fight against this global challenge.10 Pharmacological measures alone cannot help to manage the high Blood pressure. Moreover people in the modern world are under more stress, which is a primary cause for Hypertension, as they are leading a solitude life so the investigator strongly felt that a need for an interventional strategy to control the Hypertension, Alternate nostril breathing (Nadi shodhana),being simple, cost effective and easily practicable one that would definitely help the hypertensive clients to regulate their Blood pressure. It is used as an interventional strategy to control Hypertension and decrease Blood pressure.
A study to assess the effect of Alternate nostril breathing (Nadi Shodhana) on Blood pressure among Patients with Hypertension in Kannur Medical College Hospital at Anjarakandy.
1. Assess the level of Blood pressure among Patients with Hypertension in the Experimental and the Control group.
2. Determine the effect of Alternate nostril breathing (Nadi shodhana) on Blood pressure among Patients with Hypertension in the experimental group.
3. Find the association between the pre-test level of Blood pressure among Patients with Hypertension and selected Socio-personal variables such as age, sex, education, economic status, diet and exercise.
Effect:
It is the desired change in the level of Blood pressure after practicing Alternate nostril breathing (Nadi shodhana)
It is the art of practice of ten cycles of, breathing through alternate nostrils per day for three weeks to decrease Blood pressure by enhancing the autonomic control of the heart
It is the force exerted by the blood against the blood vessel walls as it flows through them. It is measured using a sphygmomanometer.
Adults, both men and women, diagnosed to have pre Hypertension and grade I Hypertension as per JNC VIII classification of Hypertension.
REVIEW OF LITERATURE:
The review of literature for the present study has been taken up from different sources like text book, journals, articles and published research studies. The literature reviewed for the present study is organized and presented in the following headings.
1. Incidence and prevalence of Hypertension
2. Complimentary therapies to control Blood pressure.
3. Effect of Alternate nostril breathing on Blood pressure.
RESEARCH METHODOLOGY:
Quantitative evaluative research approach was adopted Research design
Research Design:
Quasi experimental Non-equivalent Pre-test post-test control group design was used in this study.
|
Group |
Pre-test |
Treatment |
Post-test |
|
E |
O1 |
X |
O2 |
|
C |
O1 |
- |
O2 |
E-Experimental group
C: Control group
O1: Pre-test assessment
X-Alternate nostril breathing (Nadi hodhana).
O2: Post-test assessment
· Independent variable: Alternate nostril breathing (Nadi Shodhana)
· Dependent variable: Blood pressure of Patients with Hypertension
Setting of the study:
patients with Hypertension.
Sample:
Study sample comprises of 60 patients(30 in the Experimental group and 30 in the control group) aged 40-60 years, admitted in various medical and surgical wards who are diagnosed to have Hypertension and who all were available at the time of data collection.
Purposive sampling technique was used as they have fulfilled the inclusion criteria.
Following tools were developed to collect data for the study.
Part A: Questionnaire to collect Socio personal variables:
A structured interview schedule was used to collect the characteristics of the sample. It consists of questionnaire to collect the socio personal variables of adults with Hypertension such as age, sex, education, occupation, marital status, diet, socio- economic status, and additional details on Hypertension and complimentary therapies.
Part B: Clinical assessment form for selected variables of Hypertension
This is the tool to collect the clinical variable. It includes Systolic Blood pressure and Diastolic Blood pressure.
Part C: JNC VIII classification of Blood pressure.
Reliability of the tool:
The tool was found to be reliable. The reliability was calculated by Interrater method. It was established by percent agreement in the two rater model. After ensuring the caliber of the instrument researcher herself conducted the measurement of Blood pressure of 6 patients. After 30 minutes.The measurement was repeated on the same subjects by another trained person. Item wise percentage analysis was done and the total percentage agreement by the two raters was found as 83.33% which indicate high agreement. So the reliability of the tool was found to be 0.83(>0.7).
First two days were the period for collecting data from the control group. In that on the first day the investigator met 20 subjects (12 male and 8 female), and on the second day 10 subjects (5 male and 5 female), each sample at bed side and explained about the purpose of the study and confidentiality was assured. After taking consent from each subject the Blood pressure was checked and recorded. All the subjects were ready to participate in the study. Researcher spent about 5-10 minutes with each subjects to collect data. Post test was conducted after 3 weeks.
As like the control group, the investigator met 12-13 subjects per day, each subjects at bed side and explained about the purpose of the study and confidentiality was assured. After taking consent from each subjects the Blood pressure was checked and recorded. Then the experimental group was taught the technique of Alternate nostril breathing (Nadi Shodhana) and instructed to practice 10 cycles of which per day for next 3 weeks during dusk time. Demonstration of Alternate nostril breathing (Nadi Shodhana) was done on the same day of pre-test. The average time taken for pre –test and teaching session was about 10-15 minutes. From the same day onwards the subjects were instructed to practice Alternate nostril breathing (Nadi shodhana). Till discharge they were doing under the direct guidance of the investigator. After discharge from the hospital follow up was done through phone weekly once. And the post test was done after 3 weeks in the hospital by checking Blood pressure.
Section I: Socio-personal variables of the subjects:
Following were the major findings of the study:
· The highest percentage of patients participated in the study (38.33%) were in the age group of 50-54 years. whereas 21.66% were at the age group of 55-60 years and only 20% in the age group of both 40-44 years and 45-49 years.
· Majority of the subjects in the study were males (55%) and 45% of the subjects were females. This finding is similar to the findings of the study by Everett B, on Gender differences in Hypertension and Hypertension awareness among young adults. The study concluded that men have higher levels of Hypertension and lower levels of Hypertension awareness than women.68
· Among the subjects 26.66% were having Coolie as occupation and a 31.66 % of them were doing business, 20% were farmers, only 5% were various professionals, and another 16.66% were jobless
· Dietary habits of the subjects observed as majority (95%) preferred mixed diet, and remaining 5% of them were vegetarians. The finding of the study can be coined with another study done by Kokubo Y on prevention of Hypertension and cardio vascular disease.in which the researcher concluded that Fruit, fiber and vegetables or cereal fiber was inversely associated with the incidence of Hypertension. Therefore, diets higher in fruits and vegetables may reduce the risk of developing Hypertension.11 So researcher suggested to have diet rich in vegetables, which will reduce the incidence of Hypertension.
· It reveals that majority of the subjects (53.33%) were not having any habits like Alcoholism Smoking, Chewing tobacco.46.66% of the subjects were having habits of the same.
· It reveals regarding the practice of regular exercise that, 60% of the subjects were doing regular exercise and of the 40% were not doing regular exercise.
It revealed that during the pre -test majority of the subjects in both the experimental group (76.66%) and the control group (30%) had Grade I Hypertension and (53.33%, 70% respectively) during post–test. In the experimental group and control group remaining samples were having pre-Hypertension during both pre-test and post-test.In control group during pre-test and post-test the percentage of patients having pre-Hypertension (30%) and Grade I Hypertension (70%) remained same.
The findings are supported by the result of the another study conducted in the north Indian state of Punjab in sample of 5127 individuals aimed at estimating the prevalence of Hypertension and pre-Hypertension and the risk factors of Hypertension.It was found that prevalence of pre-Hypertension, isolated diastolic and isolated systolic Hypertension were 40.8% (39.5-42.2%), 9.2% (8.4-10.0%) and 6.5% (5.9-7.2%) respectively.The study reported alarmingly high prevalence of Hypertension.12
It shows that the mean post-test Systolic (139.26) and Diastolic Blood pressure (89.26) is lower than mean the pre –test Systolic (144.66) and Diastolic Blood pressure (90.8) in the experimental group. The calculated‘t’ value for both the Systolic Blood pressure (13.21) and Diastolic Blood pressure (2.71) is greater than the table value (t 29 = 2.045) at 0.05 level of significance.
The findings are supported by the result of another study conducted to determine the responses of Alternate nostril breathing on some cardio-respiratory functions among healthy young adults. The subjects were performed Alternate nostril breathing exercise (15 minutes every day in the morning) for four weeks. Systolic Blood pressure and Diastolic Blood pressure was decreased significantly; Results indicate that regular practice of Alternate nostril breathing (Nadisudhi) increases parasympathetic activity and since it is useful in reducing Blood pressure.13
When comparing the post-test means of Blood pressure it was found that the mean post- test Systolic Blood pressure in the experimental group was significantly lesser than that of the control group (t58= 2.57, p< 0.05) and there was no statistical difference in the mean post- test diastolic Blood pressure of the experimental with control group (t58= 1.2, p> 0.05). These findings are consistent with the results of another Quasi Experimental study conducted in Unicare Hospital, Rajkot to assess the effectiveness of Alternate nostril breathing on Blood pressure among hypertensive clients. The sample size was 40(20 under Experimental group and 20 under Control group)
|
Parameter |
Mean |
Mean difference |
Standard deviation |
‘t’ value |
|
Experimental Group |
139.2 |
5.46 |
4.72 |
2.57 |
|
Control Group |
144.7 |
9.87 |
*0.05 level significant
The association between the pre-test mean Blood pressure and selected Socio- personal variable was found that, for both Systolic and Diastolic Blood pressure there were a significant association only with age, education, and exercise at 0.05 level of significance.The finding related to significant association of education and age with pre- test level of Blood pressure was in consistent with the result of another study conducted in Brazil.Socio demographic characteristics analyzed were gender, racial self-identification, age and educational attainment and Hypertension was influenced by gender and race.14
The study deals with the effect of Alternate nostril breathing (Nadi Shodhana) on Blood pressure among patients with Hypertension. Considering the facts it can be opined that a regular practice of Alternate nostril breathingis effective in reducing Blood pressure in patients with Hypertension. So this simple intervention can be prescribed to Hypertensive patients with proper monitoring along with medical therapy because it is cost effective method of Hypertension control measure and practiced at home set-up without any equipment.
· Nurses are the vital part of health care team for assessing, planning and evaluating the outcome of any kind of treatment. Nurses have to realize their responsibility in creating the awareness regarding the effectiveness of various complimentary therapies to control Blood pressure including Alternate nostril breathing. Nursing education.
· The nurse educators and student nurses must have thorough knowledge about the various management strategies of the Hypertension to improve the quality of life of patients with Hypertension. In the Nursing curriculum,yoga practices can be added and utilize in clinical practice while taking care of Hypertensive patients.
· Nurses play a vital role in disseminating the newer safe practices in health care especially to help hypertensive adults by reducing the mortality and morbidity due to wrong practices. Thus it improves the quality of life for not only the individual patients but also that of the family and community.
· The nurse administrators should take active part in arranging Alternate nostril breathing classes for the staff nurses as well as patients, thereby improving the standard of nursing and research based nursing practice.
· Adequate knowledge, motivation and encouragement by the management and authorities of organization can be enabling various research activities. This could be the quest of many novice nurses, when motivated to indulge in research activity could improve the body of knowledge of the profession.
· A similar study can be replicated on a large group of sample.
· A similar study can be conducted in community setup.
· A similar study can be conducted with increasing the duration of the intervention more than three weeks.
· A similar study can be conducted to find the immediate effect of the intervention on a large group of sample.
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Received on 11.11.2024 Revised on 13.12.2024 Accepted on 06.01.2025 Published on 23.05.2025 Available online from May 26, 2025 A and V Pub Int. J. of Nursing and Med. Res. 2025; 4(2):63-68. DOI: 10.52711/ijnmr.2025.13 ©A and V Publications All right reserved
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