Abstract
The study’s objective is to determine the impact of exercise on the blood pressure, sleep, and mood of adults above 18 years old. The study pays attention to both physically active and people with a sedentary lifestyle within the same age group. The null hypothesis states that there is no advantage in exercising for adults above 18 years old on blood pressure, sleep, and mood. The alternate hypothesis seeks to establish the positive impact of exercise on the quality of sleep, blood pressure, and mood in adults above 18 years. A range of related records (approximately 476,458) was retrieved from electronic databases and selected on basis of their title, availability, and perceived contribution to the study objectives.
Records that were considered relevant are those whose technique involved human trials to inform on the benefits of exercise. The title threshold accounts for the exclusion of 476, 345 records while 28 were missing. 50 out of 85 records whose abstract was screened were excluded and 12 were unavailable. Other measures of credibility like the adopted study design, methodology, correctness of statistical analysis, and adherence to research protocol were also used in the selection of the records, giving rise to 15 utilized records out of the 23 that were fully screened. The results establish that exercise tends to decrease blood pressure and related health problems. It also improves mood and sleep quality by lowering physiological and psychological stress. Exercise has a positive effect on the overall quality of life. There is a need for further research because little research paid attention to the role of exercise on sleep and mood quality as well as suitable regimen exercises for specific age groups.
Introduction
Exercise has been found to have a beneficial effect on the health of individuals. In this study, and review of literature on the subject will be analyzed to help ascertain whether regimen exercises help to lower blood pressure, improve sleep and mood. In this systematic review, a comparison will be made between individuals who are actively involved in exercises and those who lead a sedentary lifestyle.
PICO Question
Do adults over 18 years with daily 30 minutes of regimen exercise have an advantage compared with the same group with a sedentary lifestyle?
Study Retrieval and Selection
A computer search was conducted on electronic databases. About 476,458 results were found. These records were screened based on their title. About 476,345 records were excluded because their titles did not meet the required threshold and purpose. 28 records were missing and were, therefore, not included in the study. About 85 articles were screened based on the abstract; 50 were excluded while 12 were not available. 23 records were screened full text. Two records were eliminated because they lacked a control group. Three records were also excluded because they did not meet the primary study requirement. Seven of the 23 records were also excluded from the study since they lacked any relevant outcome measure. One record was excluded because the study did not involve human samples.
Inclusion and Exclusion Criteria
Inclusion
Studies that involved participants above the age of eighteen were included in the study. Moreover, studies that involved human trials and which had control groups were also included. Studies with relevant measures of outcome were also included in this review. Studies that demonstrated the ability to eliminate major sources of bias were preferred for the study. A critical quality for the articles included in the study was the ability to abide by the planned protocol developed before the onset of the study.
Exclusion Criteria
Studies with participants below the age of eighteen were excluded from this review. Moreover, those that did not involve human samples were excluded from this study. Studies whose outcome did not reflect relevance in the outcomes were also excluded. Other studies that were excluded from this study include those which showed inconsistency between the study design and the research question they were meant to address as well as those that did not prove beyond a reasonable doubt that they were able to eliminate the major sources of bias. Articles with incorrect statistical analysis were also excluded from this study.
Presentation and Synthesis of Included Research
Several methodologies were used to evaluate the validity of the selected research articles. This helped isolate the most appropriate, and high-quality studies to inform the study on the effects of exercises on blood pressure, mood, and sleep. The following questions helped assess the suitability of the selected articles:
The relevance of the Research Question
Research questions seek to address what is not yet already known. They, therefore, seek to fill a knowledge gap. An article ought to address a significant topic and seek to make new contributions. The relevance of the research article was, therefore, an important criterion in the selection of a study article.
Contribution of the Article
New ideas are developed from work previously done by others. Research articles that substantially contribute to knowledge are quite rare. However, those that make incremental advances prove to be also valuable. Thus, the contribution of a research paper towards the effects of exercise on blood pressure, sleep, and the mood was taken into account.
The Type Research Questions a Study Poses
It is critical to identify a particular study problem that an article intends to address. This will help determine the ideal study strategy. It also weighs on the relevance of research outcomes. An optimal research question should address the population, study parameters, and the outcomes of interest. In our case, studies ought to have participants above the age of eighteen. The parameters to be included in the analysis were exercise, sleep, mood, and blood pressure. The outcomes of interest were whether individuals involved in at least thirty minutes of exercise had lowered blood pressure, better sleep, and mood.
Appropriateness of the Study Design for the Research Question
A major consideration in the selection of studies is the study design. The findings of most RCTs are limited due to the poor selection of the study design. Studies trying to address problems on effectiveness have well laid down study designs based on the extent to which the design shields against bias.
Effectiveness of study Method in Eliminating Major Sources of Bias
Research articles selected for this study are preferably able to address the major sources of bias. The study methods utilized should help protect against bias. Bias could occur in the selection of participants of the study, data collection methods, or how a researcher analyzes and interprets results. For instance, in studies involving Randomized Controlled Trial, computer-generated distributions are preferred to maybe numbers at the end of an individual’s birth year.
How Well the Study Abides by the Original Protocol
This is important since the deviation from the initial procedure could greatly influence the legitimacy of the results obtained. An example is a failure to incorporate the intended number of participants. The sample sizes ought to be as they were projected during the planning phase. This is a major problem facing RCTs. It is estimated that more than 30% of RCTs utilize less than 5% of the intended sample size. This greatly compromises the results obtained from such studies.
Whether the Study Tests a Stated Hypothesis
This helps protect against obtaining untrue results e.g. false-positive results. It is, therefore, preferred that studies have a given hypothesis that they are trying to test. This is because studies without hypothesis given before the study are likely to give compromised results.
Correct Statistical Analysis
This is another method used to establish the quality of a given study article. Articles with well-performed statistical analyses are likely to be more credible than those that are not. It was, therefore an important inclusion and exclusion criterion in the selection of articles for this study.
Whether the Conclusions are Justified by the Data Presented
The conclusions presented by the authors were also checked for their consistency with the data presented. Some researchers may be bent to overemphasize significant findings that are of little or no clinical consequence. On the other hand, they may overlook huge and possibly important differences between groups but which hold no statistical significance. Generalization is also another source of unjustified presentation of data. Studies were, therefore checked, for accuracy of the results as well as how they were presented.
Results
Mood
A study was done by Evangelista et al. established that there was a correlation between exercise capacity and a decrease in depression and anxiety; as well as an increase in the quality of life. Their study involved patients with heart failure. The study drew from 71 participants who were categorized into four groups based on changes in exercise capacity from baseline to six months. Patients in all groups showed lower levels of depression and hostility. They also showed advanced levels of physical and overall quality of life. However, with time, group differences were noted in levels of anxiety, depression, physical quality of life, and overall quality of life (Evangelista, Cacciata, Stromberg, & Dracup, 2016).
An analysis of randomized controlled trials by Krogh, Stern, Nordentoft, and Lawlor (2015) found that exercises have a small, short-term effect in relieving symptoms of patients with depressive symptoms. However, this effect was not found after ten weeks of intervention and it was established that long term effects were marginal. These conclusions were arrived at through data analysis. However, these findings do not present a strong case since the trials analyzed were varied, limited in number, small, and low quality (Krogh et al., 2015).
A study by Ensari et al. found that yoga yielded improvements in overall acute mood symptoms. Walking was found to improve feelings of vigor. This study suggests future studies be conducted on the long-term effects of exercise-training (Ensari, Sandroff, & Motl, 2016).
Exercises have been found to diminish symptoms of nervousness (Stonerock et al., 2015) carried out a study to evaluate the literature on exercise training in adults with high anxiety levels. In the studies that were assessed, adults with high anxiety levels were randomly assigned to exercise or non-exercise control condition. Evidence from 12 random controlled trials showed that exercises were important in reducing levels of anxiety. However, from this study, it was found that the majority of randomized controlled trials had numerous methodological limitations. These included small sample sizes and therapies that involved more than one treatment at once (Stonerock, Hoffman, Smith, & Blumenthal, 2015).
Blood Pressure
In a different study trying on exercise and weight loss as a way of reducing blood pressure, it was found that exercise alone could effectively help reduce blood pressure. However, it was also found that behavioral weight loss programs enhanced this effect. This was established to be successful in the management of elevated levels of B.P in sedentary overweight individuals. The study involved one hundred and thirty-three men and women with unmedicated stage 1 to 2 hypertension. The individual was indiscriminately allocated to a behavioral weight management program that included exercises or to aerobic exercise only. There was also a control group. The aerobic exercise involved a behavioral weight management program that involved exercises. Systolic and diastolic BPs were measured daily. Individuals who were in the weight management program had higher reductions in blood pressure at 7 mmHg and 5 mmHg systolic and diastolic pressure reductions respectively. On the other hand, individuals who only participated in aerobic exercises experienced a reduction of 4 mmHg systolic and diastolic blood pressure. The blood pressures for individuals in the control groups did not change. It was also found that individuals in both treatment groups had an increased cardiac output when compared to controls (Blumenthal et al., 2000).
In a study investigating the consequence of isometric resistance training (IRT) on hypertension in adults, it was found that exercises helped lower SBP, DBP as well as mean arterial blood pressure (MAP). The study involved an analysis of randomized controlled trials that spent more than two weeks examining the effect of isometric exercise training on the blood pressure of healthy adults (Inder et al., 2016).
Sleep
Sleep and exercise have been found to have some form of reciprocal interaction. This involves multiple physiological and psychological pathways. According to Chennaoui et al, moderate aerobic exercise training could be used as a non-pharmacological treatment of sleep disorders. Chennaoui et also recommend that future studies focus on trying to understand the complex physiological effects of exercise on sleep, both in healthy subjects as well as patients (Chennaoui, Arnal, Sauvet, & Leger, 2015).
In research done by Kreglow et al, it was found that acute physical exercise has a small beneficial effect on total sleep time. This was also true for sleep onset latency, sleep efficiency, stage I sleep, and slow-wave sleep (Kredlow, Capozzoli, Hearon, & Calkins, 2014). The study also found that acute exercise had a moderate beneficial effect on total sleep onset and a small effect on Rapid Eye Movement sleep. On the other hand, regular exercise was found to have a small beneficial effect on total sleep time as well as sleep efficiency. It was also found to have a small-to-moderate beneficial effect on sleep onset latency, and moderate beneficial effects on sleep quality (Kredlow, Capozzoli, Hearon, & Calkins, 2014).
Quality of Life
Studies have shown that exercise treatment could potentially change metabolic risk factors and brain physiology as well as enhance function after stroke. Moore et al. purposed to study the short-term metabolic, brain, intellectual, and functional effects of exercise post-stroke (Moore et al., 2014). The study involved forty participants over fifty years and with over six months of post-stroke period. The participants were autonomously mobile. They were recruited to a single-blind, parallel, randomized controlled trial of community-based exercise. Major outcome measures included glucose control and cerebral blood flow. Ancillary outcome measures included cardio-respiratory fitness, blood pressure, physical and cognitive function (Moore et al., 2014). There was no effect on glucose control, both in the treatment and the control groups. However, exercise was found to increase blood flow to the medial temporal lobe. Cardio-respiratory fitness and diastolic blood pressure were found to improve with exercise. Moreover, physical and cognitive function were also found to improve with exercise.
Discussion
The research on physiological effects on exercise provided more consistent findings regarding its possible health benefits compared to the research on its psychological effects as a few controversies in studies on exercise-mood, and exercise-sleep links were identified. Results of the literature review revealed that patients might show a moderate to a high decrease in blood pressure, improvement in blood flow and cardio-respiratory performance, and overall enhancement in both physical and cognitive functioning due to engagement in regular training (Moore et al., 2014; Blumenthal et al., 2000). A few of the studies demonstrated that exercising may have favorable impacts on individuals’ mood, psychological well-being, and emotional control resulting in fewer anxiety and depression symptoms (Stonerock et al., 2015; Evangelista et al., 2016; Ensari et al., 2016). At the same time, it was observed that the degree of effects, as well as their duration, may vary in different population groups (e.g., patients with depressive disorders vs. healthy individuals). Additionally, different results may be attained when administering acute and regular exercise interventions. This observation is especially applicable to training-sleep correlations as the reviewed studies did not provide conclusive findings concerning the given issue.
Overall, the reasons why training routine may be superior to some aspects of health and has lesser impacts on other psychological and physical functions of study participants were explained only partially in the reviewed articles. It is clear the whole-body involvement in movement especially if previously a person was less active can lead to some enhancement in body functions. At the same time, the factor of exercise novelty may play an essential role in the intervention of mood problems. For instance, patients’ depressive symptoms in the study by Krogh et al. (2015) seemed to diminish when exercise was outside the participants’ daily routine. Thus, further investigation of the involved mechanisms is required.
Implications for Practice and Research
Engagement in physical exercise can be regarded as a potentially effective method for the treatment of multiple psychological, physiological, and cognitive disorders and can be utilized as an integral part of comprehensive interventions. The findings of the conducted literature review have the potential to affect behavioral, mood, and lifestyle problems in both residents of various clinical settings, as well as the visitors of outpatient hospitals, and their families because they provide the evidence needed for effective health promotion and health intervention design. However, it is possible to say that to increase the efficacy of treatment using physical training, interventions must be targeted and addressed to specific health problems. For this reason, the further research on the effects of exercising should take into account the measures of training mode (i.e., acute, moderate, etc.), and the presence of various psychological and physiological symptoms in study participants as they may significantly affect the research outcomes. Additionally, the investigation of the long-term effects of training compared to short-term effects on physical health, mood, and sleep is of particular interest as major limitations in this regard were identified in the scholarly literature.
Conclusion
The present literature review project was performed using high-quality scholarly evidence related to adults over 18 years or older with hypertension, sleep disorders, and psychological pathologies. Exercise has some positive effects on blood pressure, sleep, and mood. The retrieved findings suggest that physical training can help lower blood pressure, both systolic and diastolic. Therefore, daily or frequent exercising is included in multiple guidelines on the treatment of primary hypertension as part of lifestyle modifications. It is also found to reduce the symptoms of depression and anxiety, which results in a persistently bad mood. Additionally, it is observed that exercising may have some unpronounced effects on sleep. Therefore, it is valid to recommend it as a form of non-pharmacological treatment for sleep disorders. However, although the majority of studies on the issue verify the effectiveness of exercise in lowering blood pressure, improving sleep and mood, there is still very little research explaining how exercises can improve mood and sleep. The given limitation provides a solid foundation for future research. Along with this, it would be critical to find out the most suitable age-specific exercises for regimen training.
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