Mrs. Devi. S1,
Dr. L N
Samaga2
1Ph D
Research Scholar, NITTE University, Mangalore-575 018
2Professor
of Medicine, KS Hegde Academy of Medical Sciences,
NITTE University, Deralakatte,
Mangalore - 575 018
Corresponding Author
Email: deviraj2007@gmail.com
ABSTRACT:
This study examined the effect of Transcendental
Meditation on blood pressure and stress in subjects with Systemic hypertension.
The study, which used a True-Experimental design, recruited a sample of 30
subjects from a general outpatient clinic. Fifteen subjects received
Transcendental Meditation training. The meditation is taught in a
self-administered program, requiring one hour of training during the first
three days, followed by the regular twice daily practice. Each 15-minutes
session consists in sitting quietly with closed eyes while applying a specific
mental procedure practiced at home daily. The 2, 4 ,6 weeks assessments were
made on stress levels, BP levels systolic blood pressure, diastolic blood
pressure and Heart Rate. Transcendental Meditation training had an immediate
effect, reducing pulse rate 4.02 beats/min, Stress level 0-6 score, systolic
blood pressure 0-4 mm Hg, and diastolic blood pressure 0-3 mm Hg. After 2, 4, 6,
weeks of Transcendental Meditation training, further decreases in pulse rate
(0-6 beats/min), systolic blood pressure (2-9 mm Hg), and diastolic blood
pressure (1-7mm Hg) occurred. Transcendental Meditation significantly lowered
patients' perception of stress (P <0.905), and it enhanced their perception
of health and wellbeing. Transcendental Meditation is beneficial for patients
with systemic hypertension, and nurses can use it to enhance their independent
function as well as their quality of life.
KEYWORDS: Transcendental Meditation; Blood pressure;
Stress; Meditation; Relaxation Therapies.
1. INTRODUCTION:
Hypertension is an important public health concern
around the world. 1,2
It is the most common risk factor for cardiovascular and cerebrovascular diseases in developed and developing
countries.3,4 During the past 25 years in India , the
morbidity associated with hypertension has increased, mostly due to changes in
the socioeconomic environment and the lifestyle of the people. 5
Hypertension is a leading cause of coronary artery
disease, cerebrovascular accident and renal failure
resulting in disability and increased healthcare system costs.6-9
Although the cause of essential hypertension is unknown, multiple risk factors
predispose persons to develop hypertension. Risk factors can be assessed, with
preventive treatment initiated for modifiable risk factors. Stress is a
modifiable risk factor for hypertension.10
Sympathetic nervous system reactions from stress cause
vasoconstriction, which increases arterial blood pressure (BP).12 In
addition, stress increases the production of neurotransmitters, such as
epinephrine, which place physiologic stress on the heart and increase oxygen
demand. 11,12 Teaching patients stress management techniques
effectively reduces stress and therefore, BP. Transcendental Meditation shows
promise as a stress management tool in patients with hypertension13-16
and is theorized to have a positive effect on BP because, by resting the mind,
breaks the stress cycle. 17-20
Transcendental
Meditation (TM)
Transcendental meditation has been shown to be
beneficial in many areas of health, including relaxation, reducing muscle
tension and promoting mindfulness.19,20,26 Physiologic research shows that the TM
technique produces a state of "restful alertness"7,8. Rest
is indicated by reduced minute ventilation, respiration rate, plasma lactate
levels, and spontaneous skin resistance responses and increased basal skin
resistance. It has been proposed that the state of restful alertness gained
during the TM technique optimizes the efficiency of the innumerable intrinsic
self-repair mechanisms of the body.9 Subsequent normalization of
accumulated physiologic imbalances through the technique could thus be expected
to help maintain good health resulting in calmness of body and mind. This
calmness leads to reduction of sympathetic activity and results in BP and HR
reduction.
Although research on the therapeutic effects of
Meditation on stress and BP reduction has been conducted in many countries,13-19
very few studies focused on the use of
Transcendental meditation to reduce stress, BP, HR, among persons with
hypertension in India, Karnataka, Bangalore . Although a relationship has been
documented between stress, hypertension, and HR, studying the effects of
Transcendental Meditation program on persons with hypertension will improve the
understanding of this safe and non invasive therapy among this group.
20,21 Transcendental meditation, congruent to the people’s philosophy of life, is becoming more
popular in India. The Ninth National Economic and Social Development Plan
promotes the integration of complementary therapies and local wisdoms into
mainstream health service to strengthen the self-reliance of the people and to
provide them with more healthcare choices.22
The Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)
recommends lifestyle modification for high BP, from pre-hypertension to
hypertension. Despite this national guideline, there is a paucity of data from
randomized controlled trials on the short and long-term effects of non
pharmacologic therapies for hypertension.25,27
Thus the purpose of the study was to determine the
effect of 6-week program of Transcendental meditation on stress and BP among
people with hypertension. On the basis of findings involving hypertensive adults it was
predicted that adults who practiced Transcendental Meditation (TM) would
exhibit greater decreases in stress levels and BP compared with a control group.
2. Materials and Methods:
Study Population
The target
population was identified as having a diagnosis of hypertension (BP > 120/80
mm Hg) and those who are currently taking and not taking antihypertensive
medications. 30 Participants were recruited (Dec -Feb2013) through purposive
sampling from the hospital clinic around 2 kilometers radius from the health
promotion program. The initial sample consisted of 30
participants; however, at study completion, no participants dropped (Fig 1)
Figure 1: Study Design
Demographic variables like age, gender, religion
education level, occupation, smoking, alcohol use and exercise habits. The modified Perceived Stress scale 14 item 23
proposed by Sheldon Cohen was used with permission to determine perceived
stress levels. Physiologic data, including BP, HR, and body weight, were taken
from the patient’s medical record and also measured by the researcher. Each
experimental group participant kept a TM Practice Record Form to indicate he or
she followed the study protocol.
The 6-week Effects of Transcendental Meditation on
Hypertension included introductory and preparatory lectures on hypertension and
Meditation, personal interview and personal instruction on technique of TM
(Mantra), and verification and validation of experiences of the first 3 days of
meditation. 6The technique was taught by qualified teacher trained
by Maharishi and it is described as "an effortless procedure for allowing
the excitations of the mind gradually to settle down until a
least excited state of mind is reached" .6 The TM program
consists of the regular practice of the TM technique 15-20 minutes twice a day. It is practiced at home, in the
office, or wherever is convenient. It does not require any special treatment
setting, and although a quiet place is best, it can also be practiced
successfully in noisy environments such as a bus, train.
The experimental group, practiced 2 times a day for 6
consecutive weeks, had routine outpatient care; for convenience, 2 temporary
checking centers were established in the community
outside of the Manjunatha clinic, Bangalore. The
experimental group received demonstrations and slide shows by the researcher.
Each session was approximately 60 minutes duration.
The control group received routine outpatient care by
hospital healthcare personnel, including general education about hypertension,
but did not practice TM routines or have stress reduction technique education.
Mean, standard deviation, and range of total stress
score were analyzed to compare stress levels between the control and
experimental groups. Paired t tests determined the difference in the mean
stress test scores before and after participating in the intervention for both
the experimental and control groups at each 2-week testing interval. A
repeated-measures analysis of variance (ANOVA) initially tested differences in
the means of BP, HR, and then again
every 2 weeks until the end of the 6-week protocol within each group and between
the control group and the experimental group. The mean stress scores of the
experimental and control groups before the experiment were compared and tested
using independent t tests to measure homogeneity of the samples.
3. Results:
The
average age of participants in the experimental group was 52.07 years and in
the control group was 49.07 years. Independent t test showed that age ranges
did not differ significantly across groups (Table.1). Nearly one half of
participants attained an education level of PUC (66.7%) (Table 3).One half of
the participants were Hindus (53.33%) 20% participants smoked and used alcohol
regularly (Table 2,4). More than one half of participants (59.3%) stated
irregular exercise. All participants (100%) had been diagnosed between 2-5
years with hypertension. No significant differences were found between the
groups in education levels, smoking habits, alcohol use, exercise habits, and
whether first or previously diagnosed as having hypertension.
Table .1: Frequency, Percentage Distribution and
descriptive statistics of patients based on their Demographic variables
|
Characteristics
|
Category |
Experimental group |
Control
group |
||||||
|
f |
% |
Mean |
SD |
f |
% |
Mean |
SD |
||
|
Age in
years |
Below 40 |
3 |
20.0 |
52.07 |
9.573 |
4 |
26.7 |
49.07 |
10.879 |
|
40-50 |
1 |
6.7 |
4 |
26.7 |
|||||
|
50-60 |
7 |
46.6 |
3 |
20.0 |
|||||
|
Above 60 |
4 |
26.7 |
4 |
26.6 |
|||||
|
Sex |
Male |
4 |
26.7 |
1.73 |
0.458 |
9 |
60.0 |
1.40 |
0.507 |
|
Female |
11 |
73.3 |
6 |
40.0 |
|||||
|
Type of
family |
Nuclear |
9 |
60.0 |
1.40 |
0.507 |
11 |
73.3 |
1.27 |
0.458 |
|
Joint |
6 |
40.0 |
4 |
26.7 |
|||||
|
Extended |
- |
- |
- |
- |
|||||
Table .2: Frequency,
Percentage Distribution and descriptive statistics of patients based on their
Demographic variables
|
Characteristics
|
Category |
Experimental group |
Control
group |
||||||
|
f |
% |
Mean |
SD |
f |
% |
Mean |
SD |
||
|
Religion |
Hindu |
8 |
53.3 |
1.47 |
0.516 |
8 |
53.3 |
1.47 |
0.516 |
|
Christian
|
7 |
46.7 |
7 |
46.7 |
|||||
|
Muslim |
- |
- |
- |
- |
|||||
|
Others |
- |
- |
- |
- |
|||||
|
Occupation
|
Unemployed/housewife/student
|
5 |
33.3 |
2.40 |
1.352 |
5 |
33.3 |
2.60 |
1.502 |
|
Govt.
Employee |
3 |
20.0 |
2 |
13.4 |
|||||
|
Private Employee |
5 |
33.3 |
5 |
33.3 |
|||||
|
Farmer/Business/Daily
wages |
- |
- |
- |
- |
|||||
|
Retired |
2 |
13.4 |
3 |
20.0 |
|||||
Table .3: Frequency,
Percentage Distribution and descriptive statistics of patients based on their
Demographic variables
|
Characteristics
|
Category |
Experimental group |
Control
group |
||||||
|
f |
% |
Mean |
SD |
f |
% |
Mean |
SD |
||
|
Marital
status |
Married |
14 |
93.3 |
1.20 |
0.775 |
15 |
100.0 |
1.0 |
0.000 |
|
Unmarried/Single |
- |
-- |
- |
- |
|||||
|
Separated/divorced |
- |
- |
- |
- |
|||||
|
Widow/Widower |
1 |
6.7 |
- |
- |
|||||
|
Educational
status |
Non literate |
- |
- |
3.87 |
1.187 |
- |
- |
3.80 |
1.082 |
|
Primary
Education/Up to 5th Standard |
3 |
20.0 |
3 |
20.0 |
|||||
|
6th
standard to 10th Standard |
- |
- |
- |
- |
|||||
|
PUC |
10 |
66.7 |
10 |
66.7 |
|||||
|
Diploma/Degree |
- |
- |
1 |
6.6 |
|||||
|
Post-graduate |
2 |
13.3 |
1 |
6.6 |
|||||
|
Area of
residence |
Rural |
- |
- |
2.0 |
0.000 |
- |
- |
2.0 |
0.000 |
|
Urban |
15 |
100.0 |
15 |
100.0 |
|||||
Table .4: Frequency,
Percentage Distribution and descriptive statistics of patients based on their
personal habits
|
Characteristics
|
Category |
Experimental group |
Control
group |
||||||
|
f |
% |
Mean |
SD |
f |
% |
Mean |
SD |
||
|
Smoking |
Yes |
3 |
20.0 |
1.13 |
0.352 |
5 |
33.33 |
1.13 |
0.352 |
|
No |
12 |
80.0 |
10 |
66.66 |
|||||
|
Alcoholism
|
Yes |
2 |
13.3 |
1.13 |
0.352 |
3 |
20 |
1.20 |
0.414 |
|
No |
13 |
86.7 |
12 |
80 |
|||||
|
Dietary
pattern |
Vegetarian
|
- |
- |
2.0 |
0.000 |
2 |
13.3 |
1.87 |
0.352 |
|
Non-vegetarian
|
15 |
100.0 |
13 |
86.7 |
|||||
|
Mixed |
- |
- |
- |
- |
|||||
|
Exercise
pattern |
Regular |
2 |
80.0 |
1.20 |
0.414 |
1 |
66.7 |
1.33 |
0.488 |
|
Some
times |
3 |
20.0 |
4 |
33.3 |
|||||
|
Often |
- |
- |
- |
- |
|||||
|
Rare |
10 |
- |
10 |
- |
|||||
There were no statistically
significant differences in the mean stress test scores of the samples between
the experimental and control groups (P> 0.634) . There was a statistically significant difference at post test in
mean stress scores between the experimental group and the control group (P <0.905) (Table5,6) indicating that 6 weeks of TM practice significantly
decreased the mean stress levels of persons with hypertension in Bangalore (Fig
2).
Table 5 Comparisons
of pre test scores level of stress among hypertension patients in experimental
and control group.
|
Stress Scores |
‘t’ test value |
p-value |
|||
|
Experimental Group |
Control Group |
||||
|
Mean |
SD |
Mean |
SD |
||
|
31.46 |
3.796 |
30.46 |
5.276 |
0.487 |
0.634 |
* Significant at 5% level
Table 6 Comparisons
of post test scores level of the stress among hypertension patients in
experimental and control group.
|
Stress Scores |
‘t’ test value |
p-value |
|||
|
Experimental Group |
Control Group |
||||
|
Mean |
SD |
Mean |
SD |
||
|
24.8 |
3.827 |
30.13 |
5.418 |
2.252 |
0.905 |
* Significant at 5% level
Fig 2 Comparison of stress Scores
Repeated-measures
ANOVA determined the effects of TM practice over the 6-week period using the
mean values of SBP and DBP and HR within and between groups. The results demonstrated that mean values of
SBP and DBP and HR within the experimental group significantly decreased from
pre-test levels (P < .01) The differences of mean values of SBP and DBP and HR between groups were tested,
as well. The results demonstrated a statistically significant reduction of mean
values of SBP, DBP, and HR at weeks 2, 4, and 6, (P < .01) .In the
experimental group, both SBP and DBP gradually decreased from Week 2 of the
experiment until approaching normal level , whereas HR gradually decreased from
week 2 of the experiment, continuing to the end of the 6th week
protocol ( Fig. 3,4,5).
Fig 3 Comparison of
systolic blood pressure
Fig 4 Comparison of Diastolic blood pressure
Fig 5 Comparison of
Heart rate
The results suggest that the effects of TM
intervention decreased BP beginning at the Week 2 of the study. As the mind
experiences quieter, subtler levels of the thinking process, and then
transcends thought altogether, our body gains a state of profound rest, much
deeper than ordinary relaxation. This deep, healing rest allows for accumulated
knots of emotional and physical stress to be released—studies supports that the
body naturally restores balance where needed leading to stress reduction. 24
Selye states that relaxation disrupts the
fight-or-flight stress response, resulting in stress reduction. This study
demonstrates that TM decreases perceived level of stress, BP, and HR possibly because a restful alertness
of the mind during TM practice helps break the stress cycle, the calmness and restful alertness effect of
TM practice may slow sympathetic activity and activate the parasympathetic
system, resulting in an HR reduction that could be observed from Week 2 throughout
the entire practice. 20 In this way, a balance of body and mind may
contribute to HR and BP normalization. The body starts to maintain a more
rested, calm and energetic style of functioning even outside of meditation,
making us more resilient to stress Distance constraint was a study limitation;
hence, the researcher could not monitor the practice and changes of some
subjects after the completion of the program daily, which would have afforded
observation of practice sustainability and its effects on stress and
hypertension.
4. Discussion:
This
study examined the impact of a -6week participation in the TM technique on
stress and BP in hypertensive adults. The TM group exhibited greater decreases
in stress and systolic BP compared with little or no change in the control
group across the 6 week study. Importantly these changes were maintained at the
-3 month follow-up after formal cessation of the intervention. Although a
trend, a similar pattern was observed for diastolic BP. These findings are
consistent with and extend adult studies reporting that TM reduced clinic BP
levels significantly in hypertensive African Americans at 3 months.
A study was conducted to examine
the effectiveness of transcendental meditation among seven hypertensive
clients. Subjects learned transcendental meditation were seen weekly and took
their own pressure several times daily. After 12 weeks of transcendental
meditation, six subjects showed psychological changes and reduced anxiety
scores. Six subjects also showed
significant reduction in home and four in clinic blood pressure. Six months later four subjects continued to
derive psychological benefit and two showed significant blood pressure
reductions attributes to transcendental meditation at home and clinic. 28
A
prospective experiment on stress reduction using the Transcendental Meditation
(TM) technique and Progressive Muscle Relaxation (PMR) was conducted at a South
African firm with 80 hypertensive employees. Psychological stress decreased
significantly over 5.5 months for the TM group (p<.0002) with 73% of the
decrease in the first two weeks; for the PMR group (p<.03); and for on-site
controls at 5.5 months (p<.034). Six weeks of TM practice produced greater
reductions in psychological stress than six weeks of PMR (p<.034). Off-site
active controls who received business skills training showed non-significant
decreases; post test stress levels were higher than for on-site groups
(p<.04). Blood pressure decreased at 5.5
months by 3 mm Hg systolic (p<.05) and diastolic (p<.04) for the TM
groups but not significantly in PMR or on-site controls. 29
The
results of change in BP in the present study are clinically significant. For
example, even a 2 mm Hg reduction in diastolic BP would be associated with a
17% decrease in the prevalence of hypertension, 6% reduction in risk for CHD,
and 15% reduction in risk for stroke and transient ischemic attack. 30
This is an important finding because hypertension increases morbidity
and mortality of this group in long term. Further studies should focus on
severe hypertensive cases. Combining medicine and Meditation or other Non
pharmacologic therapies on the basis of the individual’s preference is
indicated to reduce drug use and more appropriately control BP. It is suggested
that future studies explore the use of Transcendental Meditation on other
populations with stress-related health problems. It is a matter of broad consensus that stress in the
workplace has reached epidemic proportions. 29 So bad
has the problem become, that stress is now a more common cause of long-term
sick leave than stroke, heart attack, cancer and back problems, according to a
report by the Chartered Institute of Personnel and
Development. Workplace stress has been
labelled “The Black Death of the 21st Century. Finally,
Nurses in community health settings in India should encourage patients with
stress and Pre, mild, moderate and severe hypertension to participate in
Transcendental Meditation programs, which can lower BP and reduce the need for
medication. By educating their patients regarding the effects of Transcendental
Meditation and explaining how TM practice can be beneficial, nurses can help
patients actively participate in their healthcare.
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Received on
10.11.2014 Modified on 18.11.2014
Accepted on
02.12.2014 © A&V Publication all
right reserved
Asian J. Nur. Edu. and Research 5(1):
Jan.-March 2015; Page151-156
DOI: 10.5958/2349-2996.2015.00032.4