# Exercise as it relates to Disease/How effective is collective exercise on the mental health of elderly hypertensive patients?

This is a critique of the journal article titled "Intervention of Collective Exercise on the Mental Health of Elderly Hypertensive Patients".

## What is the background to this research?

Hypertension is a highly common, non-communicable disease that afflicts large portions of the population worldwide. 1.28 billion cases of hypertension in adults between the ages 30-79 are estimated to be active as of 2021. Hypertension is a chronic increase of blood pressure, both systolic and diastolic, to exponentially high levels.It is classified into three grades with grade 1 being the most mild and grade 3 the most severe. It is also major risk factor in many diseases and cardiovascular events, such as Alzheimer's and heart failure.
Hypertension has also been linked to poor mental health and the development of mental health disorder such as depression and anxiety. Unfortunately, many people who have hypertension are unaware of the condition and are therefore unable to seek medical assistance, be it pharmacological or otherwise. Thankfully there are a range of treatments for the condition, such as lifestyle changes (exercise and diet), pharmacological treatments (blood thinners and cardiovascular muscle relaxants) and psychological (strategies to reduce stress and anxiety).

## Where is the research from?

* This paper was published in the Iranian Journal of Public Health in March of 2016. This journal has a rigorous publication process in which papers are subject to multiple 'in-house' evaluations, which are followed by a double-blind peer review system.
* Authors Wenxin Xu, Menglong Li, and Jiwei Yao are from Fujiun Normal University, Hunan First Normal university and Hunan University of Science and Technology respectively, in China. The research was conducted in the Fuzhou city of China and used residents of the Iou, Jinan, Taijiang, Cangshan and Mawei Districts.
* A specialist/physician of cardiovascular medicine and a psychological consultant assisted with the trial, with both being from First Affiliated Hospital of the Fujian Medical University in Fuzhou City in China.
* Participants were selected between May 2012 and January 2015 and data for this study was collected over a period of 12 week period during this time.

## What type of research article was this?

This was a randomized intervention study, due to participants being randomly placed into control and experiment groups.
The aim of this study was to ascertain the effectiveness of collective or group exercise in altering the mental health of elderly hypertensive patients. A further objective was to observe whether there were any changes in coping behavioral patterns.

## What did the research involve?

* 115 elderly hypertensive patients, aged between 60 and 70 years old were randomly selected to participate. The course of hypertension was highly variable, ranging from 1 year to 15 years, with an average of 6.2 years.
* These 115 participants were then randomly divided into two groups.
** One control group consisting of 57 patients, 25 females and 32 males with an average age of 66.5 ± 11.1 years. These patients did not engage in any regular exercise and accepted regular hypertension treatment according to assisting cardiovascular specialist's advice.
** One trial group consisting of 58 patients, 30 females and 28 males with an average age of 68.2 ± 12.1 years. This group exercised four times per week and alternated between Baduanjin (a form of Qi Gong focusing on gentle utilization of the entire body) and elderly ballroom dancing (ballroom dancing with movements and tempo adjusted for elderly participants). There was a rest period of 1-2 days between each exercise session.
** Participants mental health and coping mechanisms were examined through the SCL-90 scale and the simple coping style questionnaire

## What were the basic results?

There were significant differences between the control and trial groups. Positive coping styles were reported being significantly higher in the trial group compared to the control group whilst negative coping style score was significantly lower than that of the control group. SCL-90 total score and individual measure scores were significantly different between the groups as well. All individual measures except the terror and mental disease scores were significantly lower in the trial group than the control.
There were also significant differences between scores taken before and after the study within the trial group. SCL-90 total score and individual measure scores were significantly lower post-intervention than those reported beforehand. Terror and mental disease scores were not significantly affected. Positive coping score was significantly higher post-intervention.
In the control group there was no significant difference between data recorded before or after the study.

## What conclusions can we take from this research?

It was concluded by the authors of this study that collective exercise can effective improve the mental health of elderly hypertensive patients. Collective exercise granted patients access to not just exercise but regular social contact and opportunities to form and improve interpersonal relations, both of which have been found to strongly influence the mind-body problems (anxiety, depression, etc.) that elderly hypertensive patients suffer from.
This conclusion I drew from the study coincides with the author's conclusions. Collective exercise is an inexpensive and accessible method of mental health treatment for elderly patients of hypertension.
Further research is needed to identify whether Baduanjin and elderly ballroom dancing are the best forms of collective exercise, as the paper states that they were selected due to the limited conditions of the study.

## Practical advice

* Collective exercise may become difficult during times of social hardship, such as in the recent (2020-?) Covid 19 pandemic, which has necessitated the isolation of many people around the world. This can be worked around through the use of technology such as Zoom to conduct classes.
* Weaknesses
** This study was conducted on a very small population and may not truly represent the effects of collective exercise on a larger scale or from differing cultural backgrounds.
** Limited number of collective exercise treatments.
* Strengths
** This study utilized multiple methods to ascertain the mental health of participants and sourced professional opinions from trained mental health professionals.
** Use of established psychological measures.
** Roughly equal ratio of male/female participants.
** Attendance was stable throughout study.
** Gender, age, education level, marital status and family economic situation did not significantly vary between the two groups.
* It should be noted that the building of an equal, mutually encouraging and positive emotional atmosphere is an important aspect of this intervention. This was found to allow elderly patients to further improve their interpersonal relationships as well as reduce their fear of disease to improve their mental health.

## Further information

* Hypertension info: https://www.who.int/news-room/fact-sheets/detail/hypertension
* Exercise and mental health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/
* Contact your GP for assessment if you suspect you might have hypertension.

## References

* ↑ XU Wenxin, Li Menglong, Yao Jiwei. (2016) ‘Intervention of Collective Exercise on the Mental Health of Elderly Hypertensive Patients’, Iranian Journal of Public Health vol 45 pp. 314-321
* 1 2 3 4 World Health Organisation, 2021. Hypertension. [Online] Available at: https://www.who.int/news-room/fact-sheets/detail/hypertension [Accessed 14 September 2021].
* 1 2 3 Genevieve Gabb (2020) ‘What is hypertension?’ Australian Prescriber vol 43 pp. 108-109
* 1 2 3 Kretchy, I. A., Owusu-Daaku, F., & Danquah, S. A. (2014). Mental health in hypertension: Assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence. International Journal of Mental Health Systems, 8 doi:http://dx.doi.org.ezproxy.canberra.edu.au/10.1186/1752-4458-8-25
* ↑ Farhud D Dariush (2017) ‘Analysis of Papers Submitted to “Iranian Journal of Public Health” during 2013-2016’, Iranian Journal of Public Health Vol 45 pp i-iii
* ↑ Zhao, F., Sun, S., Xiong, J. et al. The effect of Baduanjin exercise on health-related physical fitness of college students: study protocol for a randomized controlled trial. Trials 20, 569 (2019). https://doi.org/10.1186/s13063-019-3672-1