Effects of Tai chi in adults with chronic hypertension: Single subject approach
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Hypertension (HTN) is defined as a condition in which the measured blood pressure (BP) is 140/90 mm Hg or higher, and is a major risk factor for death. Almost 29% of the adult population in the United States (approximately 58.4 million) had reported HTN in 1999-2000. About 14% of adults in the age group 35 to 44 years and 53% of adults between 65 to 74 years of age had HTN; these figures are continually increasing. One of the effective methods to decrease BP is exercise. Tai chi (TC) has been paid attention for its versatile effectiveness for older people. Current literature on effectiveness of TC is limited. Hence the primary purpose of this study was to examine the effectiveness of TC in controlling BP in adults. The second purpose was to identify its effectiveness on the self efficacy in adults with chronic HTN. This research employed a single subject methodology, using A 1 (Baseline) - B (Intervention) - A 2 (withdrawal) design to analyze BP in the treatment group. Six individuals with chronic HTN formed the treatment group and were offered TC training sessions twice a week for eight weeks. The participants included a person using a wheelchair, a person with complete visual impairment, a person on four types of BP medications, a person with limited knee mobility, a young person with high BP, and a person with severe back pain. They were assessed at baseline, post TC intervention, and two months after the TC intervention. The study had a control group consisting of three individuals, who were assessed pre TC, post TC, and following two months of TC intervention. The outcome measures were BP, blood oxygen level, range of motion, muscle strength, waist circumference, self-efficacy and perceived stress. For BP, analysis was made using one standard deviation method with binomial test, chi square tests, and descriptive statistics for group comparison. All other measures were analyzed using the Friedman test. The results of the study show a considerable decrease in the BP following the TC intervention in all the participants who completed the stipulated sixteen TC sessions. These participants also showed increased confidence in their self efficacy to manage chronic diseases and decreased stress levels. Some of the participants showed an increased range of motion and muscle strength of the lower limbs. One participant showed increased reach and flexibility of the upper limbs. While some overweight participants showed decreased weight following the intervention in addition to the lowered BP, one participant showed increased waist circumference, a positive result for this participant. However none of the changes were statistically significant. The study found that the TC intervention had the potential to effectively decrease both the systolic and diastolic blood pressures in the participants. It had beneficial effects on the range of motion and muscle strength of the lower limbs. Additionally the perceived stress levels and the self efficacy showed improvement. However, these favorable responses are observed only if TC is incorporated routinely. This project suggests that occupational therapists should incorporate TC as a therapeutic and leisure activity on a regular basis along with other forms of exercise, as an alternative modality in treating patients with chronic hypertension. This is especially recommended for individuals with disabilities who cannot participate in other types of exercise. An important challenge is increasing the adherence rate for some individuals. The major conclusion of the project is that TC can be an effective exercise form to lower BP for people with disabilities.