Stress management through regulation of blood pressure among college students

Abstract

BACKGROUND: This paper introduces the concept of Deep Breathing and its applications as one of the means towards stress management through regulation of blood pressure among Indian College Engineering students. The underlying concept of deep breathing is that the relation between emotions and breathing is two way, i.e. not only do emotions affect the breathing, but controlled deep breathing also has an effect on emotions.

OBJECTIVE: The objective of the paper is to find out whether deep breathing technique is able to control blood pressure, and in turn, the level of stress.

METHODS: Sample students had a selection through initial screening and the students who reported high mental stress during interview were selected for the main drills. All the readings are taken using a sphygmomanometer (digital blood pressure meter). Students’ t test are used for the purpose of hypothesis testing.

RESULTS: The results indicated that the deep breathing technique provided significant results.

CONCLUSION: It is recommended that this amazingly simple and yet highly effective ancient technique of deep breathing become part of students’ routine curriculum. The paper aims at spreading the awareness of this yogic technique as one of the modes of Stress Management amongst Indian college students.

Keywords

Ordinary breathing deep breathing engineering students mental wellness reducing stress

1 Introduction

Stress is a whole-body illness, involving the body, mood and thoughts, and affects the way a person sleeps, eats and feels about him or herself, and thinks about things. People with stress and depressive illness cannot merely “pull themselves together” and get better. The symptoms can last for weeks, months, or years, if not treated. Many people face toughchallenges in life that may overlap or conflict, causing stress that can affect their health. Stress can arise out of difficulties at home, in relationships, and in the workplace.

A few Industrial researchers indicated the dominance of job related stress in manufacturing workers is due to perilous working conditions [1, 2]. Stress can occur in physical or mental forms. Stress is known to bring alterations in various physiological responses even leading to pathological states. Stress is linked with memory [3] and long term stress leads to severity of cognitive deficits [4]. Also the effects of stress on health have been studied [5, 6]. A study by Warren and Toll [7] indicates that a definite relationship exists between work stress and a person’s productivity.Too much or too little stress can reduce a person’s productivity.

Stress can lead to the following:

High blood pressure

Increased susceptibility to substance abuse and illness

Less resistance to disease

Depression

Chronic stress plays a major role in initiating and maintaining hypertension for many individuals [8]. Clinical trials have examined the effects of both cognitive behavioral techniques on blood pressure [9] and have evaluated the effects of the Transcendental Meditation technique on blood pressure [10 –18].

The Transcendental Meditation technique is a specific form of mantra meditation. The meditation practice involves the use of a mantra and is practiced for 15–20 minutes twice per day while sitting with one’s eyes closed. Transcendental Meditation involves “Mantras”, which mean a sacred utterance, numinous sound, or a syllable, word, phonemes, or group of words believed by some to have psychological and spiritual power in Sanskrit, Yoga postures called Asanas and breathing exercise called Pranayama. Bhastrika Pranayama is one of the main forms of Pranayama. Bhastrika involves both rapid inhalation as well as exhalation. This helps to increase the circulation of blood in the entire body. During rapid and forced exhalation, the chest is compressed, thereby pushing the blood towards the head. During the inhalation, the reverse takes place. This process increases the blood flow to every part of the body, increasing the vitality of all the organs and tissues. In one of the studies the impact of a Breathing Awareness Meditation (BAM) program on ambulatory blood pressure and sodium handling in African American adolescents with high-normalSystolic Blood Pressure (SBP) levels was probed. The findings demonstrate the potential benefit of BAM in reducing hypertension [19].

Earlier, it was noted that after slow Bhastrika pranayamic breathing (respiratory rate 6/min) for 5 minutes, both the systolic and diastolic blood pressure decreased significantly with a slight fall in heart rate [20].

In another paper, the effect of breathing technique during weight training on heart rate (HR) and blood pressure (BP) was measured using two breathing techniques, hold breath (HB), and controlled breathing. The HB technique posted higher but statistically insignificant (p < 0.01) values for systolic BP (p = 0.420), diastolic BP (p = 0.531), and HR (p = 0.713) than the controlled breath technique[21].

1.1 Academic stresses

An engineering curriculum is associated with a continuous evaluation system, focusing on assignments, quizzes, presentations and projects, along with regular written semester exams. The fear of failure related to the above tasks is a definite stressor [22, 23]. Working on projects requires regular interaction with teachers. Shyness, lack of practical skills and training, as well as larger class size, act as a deterrent to interact with teachers. Many researchers have pointed out that discussion, debate, questioning and explaining support active learning [24]. But in many universities, due to larger enrollments, active engagement and discussion are becoming impossible. Study by Pramanik et al. [25] reveal that low or moderate levels of stress can also interfere with task performance. Cognitive reactions of stress result in the inability to concentrate. Thus it is imperative to focus on strategies for reducing stress amongst engineering students [26].

Many students experience stressful changes in life and go through cultural adjustments [27]. Lazarus & Folkman [28] depicted, as stressors accumulate, an individual’s ability to cope or readjust can be overtaxed, depleting their physical or psychological resources. Essandoh et al. [29] found that college life may be even more stressful for students who have the added tension of learning different cultural values and language in addition to academic preparation.

Various studies have studied the impact of stress on college going students [30 –34]. The students share similar academic stressors such as, financial burdens, scholarship requirements, competition in class, family-related pressures and course-related stress [35].

Academic stressors also include student’s perception about the required extensive knowledge base and the perception of inadequate time to develop it [36]. The greatest sources of academic stress are studying for exams and competing for grades and the large amount of content to master in a small amount of time [37]. Perceiving excessive or negative stress can lead to physical and psychological reactions. According to Nandamuri and Gowthami [38] stress in academic institutions can have both positive and negative consequences if not well managed. Similar to handling a heavy and challenging workload, some students experience stress from regular academic work that is not difficult enough.

2 Stress management

The art of stress management is to keep oneself at a level of stimulation, i.e., healthy and enjoyable. Stress management programs include a combination of exercise program, meditation, yogic postures, relaxation techniques, behavior and attitude modification therapies and change in lifestyle. A very important aspect to manage the stress in one’s life is to change the attitude. This means one must have a positive attitude, i.e. one should always think positively. Hence stress management is not a ritual; rather it is a holistic system that balances one’s physical, psychological, emotional and spiritual well-being. It helps to attain a better state of concentration, peace, operational efficiency and patience.

Incessant monitoring of stress levels is vital for managing an individual’s stress. Non-invasive testing of subjects for physiological parameters such asGalvanic Skin Response (GSR), Heart Rate (HR), Blood Pressure (BP), respiration activity and ECG Electrocardiogram) are used to evaluate stress [39 –41].

2.1 Stress management through Yoga

Yoga has truly captured the imagination of scientists in recent times with a dramatic increase in the number of studies documenting various facets of this art and science [42 –45]. However, though many studies have elucidated applied aspects of Yoga in different health conditions, very few have focused on the basic research needed to understand the intricate mind-body mechanisms involved in the different yogic techniques [46].

The different Yogic psychophysiological techniques are bound to have different effects on each and every cell of the human body and this in turn will depend on the various body systems, organs, and tissues involved in the performance of such practices [47, 48]. As the role of the spinal column is emphasized in Yoga, it follows logically that the effects of forward bending postures would be different than those of back bending ones and that these in turn may be different from the physiological effects of twisting postures. As both intra thoracic and intra-abdominal pressure-volume changes affect the cardiovascular system, it is plausible that these Asanas (body postures,) will produce changes in the heart rate (HR) and blood pressure (BP). However, there is a lacuna of studies on such effects and there is only one study [49] comparing cardiovascular effects of some Asanas and that too was carried out in untrained subjects with only a single recording without pre-post comparisons. That study had evaluated only the BP during the performance of Sukhasana (sitting in a simple cross-legged position), Vajrasana (kneeling position sitting on the heels), and Dhanurasana by 25 medical students and compared these findings with the supine, sitting, and standing positions. As a pre-post comparison was lacking in that study, no concrete conclusion could be inferred about the actual effects of performing Asanas or about the recovery following their performance.

The Swara Yoga tradition also emphasizes the subtle differences existing between energy flows on the right and left sides (Pingala and Ida nadi respectively) manifesting through the ultradian rhythmicity of right or left nostril dominance (Surya and Chandra Swara respectively) [42]. Autonomic function is affected by right-left brain activity. [50 , 4] and as there is a sensory-motor crossover relationship between right and left sides of the body and the contralateral hemispheres, this leads to speculation to differences in autonomic function depending on techniques performed utilizing either right/left sides [52].

2.2 Stress management through regulation of blood pressure

In the normal course of blood circulation, the heart received impure blood in its right atrium and sends it to the right ventricle which further sends it to the lungs for purification. The purified blood from the lungs is sent back to the left atrium of the heart which passes it to the left ventricle. Then the blood is distributed to various body organs. Every bit of this blood transport step requires a stipulated amount of pressure to carry the blood further. This is called blood pressure.

The human body produces a surge of hormones when one is in a stressful situation. These hormones temporarily increase the blood pressure by causing one’s heart to beat faster and the blood vessels to narrow.

Physiology encompasses the tissue, organ and cellular functions of the human body. An optimally healthy body has normal physiology. Conversely, human disease represents an aberration in normal physiology. Hemochromatosis, iron-deficiency anemia and iron-reutilization anemia exemplify different types of physiological abnormalities that can affect body systems, leading to disease. Due to certain physiological disorders when the lumen of the arteries constrict, their volume also reduces. This creates increased pressure inside the arteries which is then referred to as Hypertension. Similarly decreased pressure inside the arteries which is referred to as Hypotension is known as Low blood pressure. The causes for this may be emotional stress, fear, and insecurity in addition to physiological interruptions caused due to any known or unknown reasons.

The systolic pressure is the maximum pressure in an artery at the moment when the heart is beating and pumping blood through the body.

The diastolic pressure is the lowest pressure in an artery in the moments between beats when the heart is resting.

Both the systolic and diastolic pressure measurements are important – if either one is raised, it means one has high blood pressure (known as hypertension which may be caused by mental stress) [53]. Hypertension places patients at high risk for target organ damage including, retina, brain, heart, kidneys etc.

Normally the blood pressure during systole i.e. systolic pressure (when the left ventricle contracts) should be not more than 120 to 130 mm / Hg. During Diastole i.e. diastolic pressure (when the left ventricle relaxes) the pressure should be about 80 to 85 mm / Hg. When these values remain elevated for a considerable amount of time, the person is said to be Hypertensive. High B.P. may have an hormonal cause among other causes leading to disruption of renin angiotensin, aldosterone actions, high B.P. may also be as a result of renal disorders.

The relationship between blood pressure and deep breathing is being researched. Rosenthal et al. [50] has reported in a study using a device-guided breathing exercise, which suggests the involvement of increased sympathetic activity [54–55] decreased baroreflex function [56 –58] and reduced arterial wall compliance [59].

Research work has been carried out to find out how and why stress happens, what is the body’s response to stress and how stress can be reduced, however very little work has been done in the area of academic stress. The objective of this paper is to find out the effect of Deep Breathing (Yoga) Technique on the academic stress level through regulation of blood pressure. In the present study, a devise called SPHYGMOMANOMETER is used to measure the blood pressure. Blood pressure is measured by inflating a cuff around the arm. It is a simple and painless procedure that gives much useful information about the heart and the condition of the blood vessels. The maximum pressure (systolic) and the lowest pressure (diastolic) made by the beating of the heart are measured.

3 Methodology

In the current study the objective is to see the effect of Deep Breathing Technique (DBT) on the blood pressure i.e. in turn manage stress.

For this, a total of 123 students from Engineering colleges from Punjab (India) were selected. The initial screening for selecting the candidates was done based on a small academic stress questionnaire, which was furnished to approximately 1000 students in the region through mails and personal contact. Based on the academic stress score, these candidates were screened and all the candidates with high academic stress were personally contacted through mails and phone. A total of 123 students responded out of 356 contacted, so the response rate is 34.55%.

For this experimental studies research, the approval by the institutional ethical committee was received and informed consent, was obtained from subjects participating in the study. The total data set was divided into two groups named as control group and experimental group. In the control group, the first readings were recorded as “before the drill readings” for Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP). The second reading was recorded as “after Ordinary Breathing Technique (OBT)”. This OBT drill continued for 10 minutes and final readings after 10 minutes were taken.

The readings taken “after Ordinary Breathing Technique” were used as a “before the drill readings” for experimental group. The third and the final reading were recorded as “after Deep Breathing Technique”. This DBT drill continued for 10 minutes and final readings after 10 minutes were taken and to record the readings of Systolic Blood Pressure and Diastolic Blood Pressure, ACON make (US) All Well-being Automatic Blood Pressure Monitor model No. OB 11-111 was used.

The entire data set is arranged and the hypothesis to be tested are shown in Table 1, using students t test at 1% level of significance.

4 Analysis and interpretation

After setting the hypothesis in the above section, the data is analyzed using descriptive statistics. We can see from Table 2 (for control group) that the average DBP is 87.75 before the OBT drill and 87.27 after the OBT drill, with a variance of 7.54 and 9.34 respectively. The SBP is 128.27 before the OBT drill and 128.82 after the OBT drill, hence the difference in both the cases is insignificant. Based on the t test, it can be seen that both the H₀₁ and H₀₂ are accepted at 1% level of significance.

In Table 3 (for experimental group), the DBP is 87.27 before the DBT Drill and 79.89 after the DBT drill, which is significantly lower and more close to the desired level of 80. As evident, the p value is less that α at 0.01, the H₀₃ is rejected and we can say that there is a significant positive effect of DBT on DBP.

On the other hand the SBP was 128.82 before the DBT drill and 121.03 after the drill again indicating a significant positive effect as the desired level is 120. The t test confirms this (H₀₄ is rejected).

Table 4 shows the status of hypothesis for control and experimental groups after testing and statistical analysis.

5 Conclusion

Based on the above analysis it can be concluded that Deep Breathing Technique has a significant positive effect on the Systolic Blood Pressure (SBP) as well on Diastolic Blood Pressure (DBP). The DBP is recorded as 87.27 before the Deep Breathing Technique Drill and 79.89 after the Deep Breathing Technique drill, which is close to the desired level of 80. Similarly, SBP was 128.82 before the DBT drill and 121.03 after the drill and close to the desired level of 120. The findings are in line with the existing literature [19 , 60] and contribute in the ongoing area. Based on the above findings, it is proposed that techniques like Deep Breathing can be made compulsory in the educational institutes to contribute to a more healthy student life. Such a practice may help in improving students’ learning and efficiency and give rise to healthy social system. College is a place where students learn about different cultures, languages and extracurricular activities. College life is a time to learn the lessons of life and come out as professionals, who are going to take up challenges in their career. The time spent in college also prepares students to meet uncertainties, which they are going to face in the future, especially in their career. Therefore, it is vital that our students not only grow academically, but remain in a healthy state of mind. They can then contribute to their personal growth, as well as to that of the nation.

Conflict of interest

The authors have no conflict of interest to report.

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