Effect of DNS Exercises Training on Hypertension

Study Overview
=================
Brief Summary
-----------------
Purpose of the study This study will be conducted to investigate any significant effect of dynamic neuromuscular stabilization training on postural control in patients with essential hypertension.

Detailed Description
-----------------
PURPOSE: This study will be conducted to investigate any significant effect of dynamic neuromuscular stabilization training on postural control in patients with essential hypertension. BACKGROUND: The most recent global estimates suggested that hypertension (HTN) affected 1.13 billion people worldwide. Raised blood pressure (BP) has emerged as the most important risk factor for global morbidity and mortality. Hypertensive individuals present slower processing speed, reduced static and dynamic balance, decreased functional mobility during both single and dual tasking and higher fear of falling in comparison to normotensive individuals. These findings expand the body of knowledge about the effects of HTN on physical functions like prolonged processing time, disturbed balance and reduced mobility functions, which may guide clinicians in including preventive and rehabilitative strategies to their therapy protocols in order to improve the quality of life of the individuals with HTN. HYPOTHESES: Null Hypothesis: there will be no significant effect of dynamic neuromuscular stabilization training on postural control in patients with essential hypertension. RESEARCH QUESTION: Will be any significant effect of dynamic neuromuscular stabilization training on postural control in patients with essential hypertension?

Official Title
-----------------
Effect of Dynamic Neuromuscular Stabilization Training on Postural Control in Patients With Essential Hypertension

Conditions
-----------------
Essential Hypertension

Intervention / Treatment
-----------------
* Other: dynamic neuromuscular stabilization training
* Other: balance exercises plus diaphragmatic breathing


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Sixty men patients with stage two essential HTN (more than 140/90 mm hg). Their age will be ranged from 50-60 years old. Body mass index (BMI) from 25 to 34.9 kg/m2. Low levels of physical activity (using the International Physical Activity Questionnaire-Short Version) (The Arabic version of the questionnaire will be used) Exclusion Criteria: Uncontrolled HTN. Diabetes mellitus. Heavy Smoker. Neurological or musculoskeletal conditions that interfere with gait Vertebrobasilar insufficiency (VBI). Use of psychotropic drugs. Impaired vision and/or hearing. Unstable medical conditions. Patients who are unable to follow verbal instructions. Participation in regular exercise training of any type in the previous 3 months.

Ages Eligible for Study
-----------------
Minimum Age: 50 Years
Maximum Age: 60 Years

Sexes Eligible for Study
-----------------
Male

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: parallel study is a type of clinical study in which two or more groups of participants receive different interventions.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: D. N.S<br>dynamic neuromuscular stabilization training methods demonstrated efficacy in improving global trunk stabilizing patterns with noted gains in extremity movement and strength | Other: dynamic neuromuscular stabilization training<br>* DNS methods demonstrated efficacy in improving global trunk stabilizing patterns with noted gains in extremity movement and strength<br>|
| Experimental: balance exercises plus diaphragmatic breathing<br>balance exercises plus diaphragmatic breathing The balance exercises is balance training while standing and walking and The patient assume a semi-Fowler's position and perform diaphragmatic breathing. | Other: balance exercises plus diaphragmatic breathing<br>* The balance exercises is balance exercises while standing and walking The patient assume a semi-Fowler's position and perform diaphragmatic breathing.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postural control by Biodex Balance System | The overall stability index (OSI), anteroposterior stability index (APSI), and mediolateral stability index (MLSI) are recorded with a Biodex Balance System, Postural stability test will be performed in the double leg standing position and in the single leg standing position on the right and left legs | 8 weeks | 
| balance by The Modified star excursion balance test (mSEBT) | • Patients will perform testing while barefoot, maintaining their hands on their hips and a series of single-limb squats using the non-stance limb to touch a point a maximum distance along designated lines on the ground | 8 weeks | 
| dynamic balance and functional mobility by Timed-Up-and-Go test (TUG) | It uses the time that a person takes to rise from a chair, walk three meters, turn around, walk back to the chair, and sit down while turning | 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sleep quality: using The Pittsburgh Sleep Quality Index (PSQI) | It is used to determine self-reported sleep quality and sleep disturbances for the preceding month. It is a 19-item test and consists of seven components: (1) subjective sleep quality, (2) sleep latency, (3) sleep duration, (4) sleep efficiency, (5) sleep disturbance, (6) sleeping medication use and (7) daytime dysfunction. | 8 weeks | 
| Quality of life: using The 12 Item Short Form Health Survey (SF-12) Questionnaire | • The SF-12 consists of 12 questions that examine eight different health domains in order to determine physical and mental health. General Health (GH), Physical Functioning (PF), Role Physical (RP), and Body Pain (BP) are the physical health domains. Vitality (VT), Social Functioning (SF), Role Emotional (RE), and Mental Health (MH) are mental health-related scales | 8 weeks |