Effects of Relaxation Exercise and Sleep Environment Modification on Stress, Blood Pressure and Sleep among Institutionalized Elderly in Nairobi City, Kenya
Githang'a, Juliah Wambui
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Stress is a key factor in reducing the efficacy of the treatment of high blood pressure and poor sleep quality in the elderly. Yet, high blood pressure and poor sleep quality are important preventable contributors to disease and death. Inadequate sleep is one of the most common side effects of stress resulting in reduced sleep quality. To effectively manage stress, the ability to relax and create a sleep inducing environment is paramount. Given the negative impact of stress on human health, many types of stress management therapies have been put forward for the elderly in order to decrease stress and promote well-being. The purpose of this study was to assess the effectiveness of Progressive Muscle Relaxation (PMR) exercise and sleep environment modification on stress, blood pressure and sleep quality of residents 60 years and above in Mji wa Huruma home for the aged in Nairobi County, Kenya. The study aimed at highlighting the benefits of PMR together with the modification of the sleep environment by use of sleep masks in management of stress, normalizing blood pressure and enhancing sleep quality of both male and female elderly citizens. The study adopted an experimental pre-test post-test control group design. A total of 46 participants were randomly selected from the home to create experimental and control groups with 23 participants in each group. After ethical clearance and research permit approval, data was collected using Perceived Stress Scale (PSS), Pittsburgh Sleep Questionnaire Index (PSQI) questionnaires and a sleep diary. Systolic and diastolic blood pressure data collected using a digital automatic blood pressure upper arm monitor was recorded. The physiological and psychological variables were assessed on both experimental and control groups at pre-test, mid-test and post-test. A total of 43 (93.5%) participants successfully completed the two months intervention programme. In the experimental group, PMR exercise was performed in 45 minutes sessions, three times weekly for two consecutive months and the participants used sleep masks during the entire intervention period. The control group, however, continued with their normal routine activities throughout the intervention period. For the purposes of comparison, data was collected in both experimental and control group. The data was coded and analyzed using Statistical Package for Social Sciences (SPSS) version 20. The results of repeated measures ANOVA and Post Hoc tests between experimental and control groups showed that there were statistically significant differences at p ≤ 0.05 between the pre-test, mid-test and post-test scores on stress level and sleep quality, F = 18.969, p = 0.001; F= 10.902, p=.002 respectively. Multiple linear regression showed a significant regression equation, F= 7.321, p ˂0.002 for stress level and F=27.408, p ˂ 0.001 for sleep quality. The repeated measures ANOVA and Post Hoc tests on systolic and diastolic blood pressure showed that there were no statistically significant differences at p ≤ 0.05 between the pre-test, mid-test and post-test scores, F = .371, p = .546; F=1.744, p=.194 respectively. Multiple linear regression on blood pressure showed a significant regression equation, F= 85.52, p ˂0.001. It was concluded that PMR and use of sleep masks were effective intervention measures in the elderly with high stress level, high blood pressure and poor sleep quality. The study recommended that PMR and sleep masks programmes should be expanded in the community areas with larger population of the elderly.