EFFECT OF CORE STABILIZATION EXERCISES ON CARDIOVASCULAR

PARAMETERS IN POSTMENOPAUSAL WOMEN

Synopsis
MASTER OF PHYSIOTHERAPY
SUBMITTED BY: POONAM SONI
Roll no: 210172690005
M.P.T. (FIRST YEAR)

Supervisor Co- Supervisor

Dr. KALINDI Dr. MEENAKSHI BAGRI(PT) ASSISTANT
PROFESSOR ASSISTANT PROFESSOR
 
 
 
DEPARTMENT OF PHYSIOTHERAPY
GURU JAMBHESHWAR UNIVERSITY OF SCIENCE AND TECHNOLOGY,
HISAR (HARYANA)
EFFECT OF CORE STABILIZATION EXERCISES ON CARDIOVASCULAR PARAMETERS IN
POSTMENOPAUSAL WOMEN
Introduction

 The menopause, which signifies the end of a woman’s reproductive years, is one stage in the life cycle of
women. Except in extremely rare circumstances where specialized reproductive procedures are performed, a
women cannot become pregnant beyond menopause. In most cases, menopause sets in between the ages of 45
and 55 as a normal byproduct of biological ageing. Loss of ovarian follicular activity and a decrease in blood
oestrogen levels lead to menopause and it can be a consequence of medical or surgical procedures. [World
Health Organization, 2022].
 Hormonal changes associated with menopause are accountable for dyslipidemic pattern that causes
cardiovascular disease and associated complications. In postmenopausal women, cardiovascular disorders are
the main cause of mortality and morbidity [Barton M., et al., 2009].
 High blood pressure is one of the main risk factors for cardiovascular disease and is responsible for 10% of
all fatalities in India [Patel V., et al., 2011].
 According to Sverre E., et al. (2018), hypertension is the strongest or one of the strongest risk factors for
nearly all types of acquired cardiovascular diseases, including coronary disease, left ventricular hypertrophy,
valvular heart disease, cardiac arrhythmias like atrial fibrillation, cerebral stroke, and renal failure.
 Women are more likely than men to experience cardiovascular disease [Ong KL., et al., 2008]. The blood
pressure increase with increase in age, but in women at a faster rate than in men.
 In postmenopausal women, the prevalence of hypertension is 41% higher than in men in the same age group
[Lima R.,2013]. Despite the fact that the medications used to treat hypertension are the same for men and
women, the National Health and Nutrition Examination Survey IV found that women were more likely to
have poorly managed hypertension than men [Kim JK., et al., 2006]. Despite the age factor, postmenopausal
women are more likely to have hypertension than pre-menopausal women of the same age.
 Even while pharmacological hypertension treatments have been shown to be effective, less than 50% of medicated hypertensive’s stick
with their treatment regimens for a variety of reasons, including harmful side effects, and many frequently fail to meet clinical goals.
 Treatment for lifestyle change is crucial due to these factors, as well as the substantial expense of hypertension to the National Health
Service (NHS). For the prevention and treatment of hypertension, regular physical activity has been advised [Chobanian AV., et al., 2003].
 Additionally, a study found that aerobic exercise can lower clinical blood pressure in both hypertension and non-hypertensive people. The
stabilization of the body's core is one of these. According to Richardson, Jull, Hodges, and Hides (1999), the core was characterized as an
anatomical box made up of 29 pairs of muscles that make up the anterior muscles (abdominals & adductors), posterior muscles
(paraspinal and gluteals), the diaphragm as the roof, and the pelvic floor and hip girdle musculature at the bottom.
 Proper weight distribution across the spine, pelvis, and kinetic chain depends on strong core muscles. Without these muscles, the upper
body’s weight as well as compressive stresses as low as 90N would cause the spine to become mechanically unstable. When everything
goes according to plan, the system generates the most force possible while generating minimal compressive, translational, or shearing
pressure at the joints of the kinetic chain.
 Numerous known risk factors for cardiovascular disease can be positively impacted by regular exercise. Numerous studies have shown
that exercise training enhances the blood vessels’ ability to enlarge in response to hormones or activity, which is associated with better
vascular wall function and a greater ability to oxygenate the muscles while exercising [Myers J., 2003].
 Physical activity has been shown to raise heart rate during the first transition of the exercise and to decrease as the exercise continues
[McGuirre DK.,et al.,2001].
 Different processes are used to modify heart rate during physical activity. The autonomic nervous system (ANS) and its sympathetic and
parasympathetic branches are active on the sinus node of auto-rhthmicity, specifically resting vagal activity, which is gradually repressed
when exercises are started and the sympatheitic activity when activities are further increased [Ekblom B.,et al.,1968 ].
 Exercises that build core strength have been recommended to improve the body's ability to transmit force. During functional exercise, an
effective core enables the best acceleration, deceleration, and stabilization of the entire kinetic chain.
 The core stability exercise requires the recruitment of more muscles, thus the motor cortex and cardiovascular control centers will be
activated simultaneously [Franke, Boettger, & Mclean., 2000]. Following a program of core exercises can reduce lower back pain, lower
plasma lipid levels, increase oxygen kinetics and recovery, improve cardiac patient function, better regulate blood pressure, and increase
skeletal muscle blood flow, which is associated with nitric oxide production [Malavia B & Shah S., 2022].
  
 Aim of the study:
To evaluate the effect of core stabilization exercises on cardiovascular parameters in
postmenopausal women.
 Objectives:
• To evaluate and compare the effect of core stabilization exercises on systolic and diastolic
blood pressure in postmenopausal women.
• To evaluate and compare the effect of core stabilization exercises on heart rate in
postmenopausal women.
• To evaluate and compare the effect of core stabilization exercises in rate pressure product in
postmenopausal women.
 Hypothesis
 Alternate hypothesis:
There is significant effect of core stabilization exercises on cardiovascular parameters in
postmenopausal women.
 Null hypothesis:
There is no significant effect of core stabilization exercises on cardiovascular parameters
in postmenopausal women.
Need of the study

 Cardiovascular conditions are more common in women than men. And it is

more prevalent in postmenopausal women as compared to premenopausal
women. Among the cardiovascular conditions hypertension is strongest risk
factor for cardiovascular condition which often remain undiagnosed or
inadequately treated, especially after menopause when chances of
cardiovascular risk increases.
 So, present study aimed at defining the impact of core stabilization
exercises in postmenopausal women on cardiovascular parameters. It may
help in controlling the blood pressure which ultimately prevent
hypertension associated cardiovascular conditions.
Methodology

 Study design
Study design is a randomized controlled trial. 
 Sampling method:
Convenient sampling method.
 Sample size
Sample size will be estimated. 
 Study groups:
There will be two groups:
Group A- Experimental group
Group B- Control group
 Inclusion Criteria: (Hoier B.,et al.,2021)
Post menopausal women
Age group 45-60 years
Physically active
Subjects willing to participate in the study
 Exclusion Criteria:
• Musculoskeletal disorders
• Obesity
• Metabolic syndrome
• Cardiovascular and pulmonary disorders
• Neurological problems like significant cognitive deficit, presence of peripheral vascular diseases, severe peripheral neuropathy
• Psychological disorders
• Smokers
• Hormone treatment during the past 10 years
• Confused or anxious subjects
• Uncooperative subjects
 Equipments & Tools
• Sphygmomanometer
• Pulse oximeter
• Weighing machine
• Stadiometer
• International physical activity questionnaire
 Outcome measures:
 Dependent variables-
• Systolic blood pressure (SBP)
• Diastolic blood pressure (DBP)
• Heart rate (HR)
• Rate pressure product (RPP)
 Independent variables-
• Core stabilization exercises
• General conventional exercises
Procedure

 The sample will be screened according to the inclusion and exclusion criteria. Prior
to the study a clear explanation and the purpose of the study will be given to all the
subjects. Subjects will be refrained from eating anything before half hour of
exercise session. All subjects will be divided into 2 groups, after randomization,
through random number table method into experimental group and control group.
Experimental group will be receiving core stabilization exercises and control group
will be receiving general conventional exercises, for 3 days in a week, for 4 weeks.
All the outcome measures will be assessed at baseline, at week 2 and at week 4.
Subjects will be instructed to not indulge in any kind of exercise session while
participating in the study.
Protocol

EXPERIMENTAL GROUP
 Core stabilization exercises
 10 repetitions × 3 sets with 10 second hold after each set for
 3 days a week
 4 weeks

CONTROL GROUP
 Conventional exercise
 10 repetitions × 3 sets with 10 second hold after each set for
 3 days a week
 4 weeks
 References
 Barton M, Meyer MR. Postmenopausal hypertension: mechanisms and therapy. Hypertension 2009; 54:11–18.
 Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama. 2003;289:2560-72.
 Fernández-Vega F, Abellán J, Vegazo O, De Vinuesa SG, Rodríguez JC, Maceira B, de Castro SS, Nicolás RR, Luño J. Angiotensin II type 1
receptor blockade to control blood pressure in postmenopausal women: influence of hormone replacement therapy. Kidney Int Suppl
2002:S36–S41.
 Hall JE, da Silva AA, do Carmo JM, Dubinion J, Hamza S, Munusamy S, Smith G, Stec DE. Obesity-induced hypertension: role of
sympathetic nervous system, leptin, and melanocortins. J Biol Chem 2010; 285:17271–17276.
 Kim JK, Alley D, Seeman T, Karlamangla A, Crimmins E. Recent changes in cardiovascular risk factors among women and men. J Womens
Health (Larchmt)2006; 15:734–746.
 Lee CG, Carr MC, Murdoch SJ, Mitchell E, Woods NF, Wener MH, Chandler WL, Boyko EJ, Brunzell JD. Adipokines, inflammation, and
visceral adiposity across the menopausal transition: a prospective study. J Clin Endocrinol Metab 2009; 94:1104–1110.
 Ong KL, Tso AW, Lam KS, Cheung BM. Gender difference in blood pressure control and cardiovascular risk factors in Americans with
diagnosed hypertension. Hypertension 2008; 51:1142–1148.
 R. Gupta, “Convergence in urban-rural prevalence of hypertension in India,” Journal of Human Hypertension, vol. 30,no. 2, pp. 79–82,
2016.
 Reckelhoff JF, Romero JC. Role of oxidative stress in angiotensin-induced hypertension. Am J Physiol Regul Integr Comp Physiol 2003;
284:R893–R912.
 Roman RJ. P-450 metabolites of arachidonic acid in the control of cardiovascular function. Physiol Rev 2002; 82:131–185.
 Steiner M, Dunn E, Born L. Hormones and mood: from menarche to menopause and beyond. J Affect Disord 2003; 74:67–83.
 V. Patel, S. Chatterji, D. Chisholm et al., “Chronic diseases and injuries in India,” The Lancet, vol. 377, no. 9763, pp. 413–428, 2011.
 Myers J. Exercise and cardiovascular health. Circulation. 2003; 107:2e-5.
 12. McGuirre DK, Levine BD, Williamson JW, Snell PG, Blomqvist CG, Saltin B, Mitchell JH. A 30-year follow-up of the Dallas Bed Rest
and Training Study. The effect of age on the cardiovascular response to exercise. Circulation. 2001; 104:1350-7.
 Ekblom B, Hermansen L. Cardiac output in athletes. J Appl Physiol. 1968; 25:619-25.
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