JOURNAL READING

INCREASING LIFESTYLE WALKING BY 3000 STEPS PER DAY

REDUCES BLOOD PRESSURE IN SEDENTARY OLDER ADULTS WITH
HYPERTENSION: RESULTS FROM AN E-HEALTH PILOT STUDY
Nama: Rizki Imanuel
NIM: 2365050030

KEPANITERAAN KLINIK ILMU PENYAKIT DALAM

RS UKI
FAKULTAS KEDOKTERAN UNIVERSITAS KRISTEN INDONESIA
PERIODE 7 AGISTUS – 16 OKTOBER 2023
IDENTITAS JURNAL

Publikasi: MDPI
Tahun publikasi: 2023
Journal homepage: https://www.mdpi.com/2308-
3425/10/8/317#:~:text=A%2020-week%2C%20single-
arm%2C%20pilot%20e-health%20lifestyle%20walking
%20intervention,an%20additional%203000%20steps
%2Fday%20for%20blood%20pressure%20control.
INTRODUCTION
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• 8 of 10 adults 65 years of age or older in the United States are burdened with high blood pressure.
• Lifestyle modification: the first line of treatment
• Walking is a practical and accessible option for older adults, and e-health interventions can be used to
promote it.
• Current guidelines recommend at least 150 minutes of moderate to vigorous aerobic activity per
week for all adults.
• The hypothesis is that the walking intervention will lower blood pressure.
MATERIAL DAN METODE
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Study Participants

• The study recruited sedentary older adults aged 65 with hypertension who were overweight or obesity, putting them
at higher cardiovascular disease risk.
• Recruitment occurred via email in September and October 2020 from the Physical Activity and Aging Study
(PAAS).
• 8 participants who were taking antihypertensive drugs were included and asked to continue their treatment.

• Individuals averaging more than 8000 steps/day were considered active and excluded from the intervention.

• The study adhered to the Declaration of Helsinki.

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Study Design
• The study used a single-arm, within-participant design, conducting assessments at baseline, 10 weeks, and 20 weeks
during the intervention period.
• The e-health intervention and assessments were conducted through digital means (e.g., video call).
• All assessments took place over 8 days.
• Participants received a box of equipment.
• Research personnel collected equipment, questionnaires, and logs on day 9 after the assessments.
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Assessments

• Participants were instructed to measure blood pressure and heart rate on days 2 and 3 using an automated device
(Omron HEM-907XL) .
• Three measurements are taken with at least 2 minutes of rest between measurements, and the average is recorded

• A 24-hour dietary recall was conducted on day 6 over the phone.

• The Self-Report Habit Index (SRHI) questionnaire was used to assess the strength of walking as a habit.

• Social cognitive determinants of physical activity: the Exercise Motivation Questionnaire at baseline and the
Exercise Action Questionnaire at 10 and 20 weeks.
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Intervention

• Baseline steps/day were measured on days 2 through 8 of the baseline assessment using a sealed.

• Baseline steps/day were considered valid if worn for at least 10 h on at least 5 of the previous 7 days.

• Participants were provided with an unsealed pedometer and a log to record steps and wear time.

• Behavior change techniques, based on the Health Action Process Approach (HAPA) Theory to help achieve step
goals.
• The study aimed to assess adherence to wearing the pedometer and adherence to the intervention separately.
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Statistical Analysis

• Normality was assessed using the Shapiro–Wilk test.

• Data confirmation: Analyses were repeated using only individuals with complete data.
• Statistical model: A linear mixed-effects model with time (repeated).
• Correlation analysis: Examine relationships between baseline blood pressure and changes during the intervention
• Statistical software: SAS software (SAS Institute, Cary, NC, USA).
• Significance level: All p-values were two-sided, with a predetermined α-level of 0.05 considered significant.
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RESULTS
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• Phone screen: A total of 59 individuals, with 16 ineligible for the baseline assessment.
• Baseline assessment: 43 eligible for the baseline assessment, 6 dropped out
• 37 participants who completed the baseline assessment.
• Of those 37, 16 participants were ineligible resulting in 21 participants.
• 2 participants were ineligible (COVID-19 (n=1), died (n=1))
• Thus, 20 participants completed the 10-week assessment, whereas 19 completed the 20-week assessment.
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• Body weight and BMI did not significantly change throughout the intervention (p > 0.05, Table 2).
Additionally, no significant dietary changes were observed for total kilocalories, protein, fat, carbohydrates,
fiber, or sodium (p > 0.05, Table 2).
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• Systolic blood pressure decreased from 137 ± 10 mm Hg at baseline to 132 ± 13 mm Hg (p = 0.008, gav = 0.41.
• No significant change in systolic blood pressure was observed from 10 to 20 weeks.
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• Further, the reductions blood pressure were not different between those taking anti-hypertensive medications and
those who were not taking anti-hypertensive medications.
• There was no significant change in resting heart rate across the 20-week.
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• The participants had high overall exercise motivation (5.38 ± 0.73) at baseline.

• At 10 weeks, however, overall exercise action was high (5.34 ± 0.90) and was strongly correlated with the
change in steps/day at 10 (r = 0.68, p = 0.001) and 20 weeks (r = 0.53, p = 0.02).

• Overall exercise action at 20 weeks was 5.22 ± 1.09, but it was not correlated with the change in steps/day at 20
weeks (r = 0.37, p = 0.12).
DISCUSSION
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• A 20-week e-health walking intervention for sedentary elderly people with hypertension was significantly effective
in reducing systolic and diastolic blood pressure at week 20 by 7 and 4 mmHg.

• Blood pressure continued to decrease by 2 mmHg during the 10-week self-maintenance phase

• Most participants preferred lifestyle interventions to structured gym-based exercise programs

• Results of this researchsimilar to that reported by Rowley et al., where walking increased from 4688 to 10,286
steps/day (~119%) after a 12-week intervention in adults aged 55–80 years who received both methods.
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• The effectiveness of e-health interventions may vary such as face-to-face contact and web-based approaches.

• There is correlation between exercise action scores at week 10 and changes in steps per day at weeks 10 and 20.

• Intervention significantly reduces the risk of death and lowers the risk of cardiovascular disease.

• Significant increase in aerobic steps at both 10 and 20 weeks.

• However, at 10 and 20 weeks, there was no significant difference in systolic blood pressure reductions for those
increasing aerobic steps by <2000 vs. ≥2000 steps/day from baseline to 10.
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• The results were similar in diastolic blood pressure (both p > 0.05 at 10 and 20 weeks).

• The study's strengths include using an e-health intervention with behavior change techniques from HAPA theory.

• High adherence and objective physical activity monitoring throughout the intervention are additional strengths.

• The absence of a control group is a major limitation, and caution is needed when interpreting the results.

• Bias may occur because the data on the number of steps/day, body weight, and blood pressure are self-reported.

• The relatively short duration of the study (10 weeks) and limited study personnel support.
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CONCLUSIONS

The results of this study show that an additional 3,000 steps/day for at least 5 days/week can reduce systolic and diastolic
blood pressure by 7 and 4 mmHg respectively in sedentary adults with hypertension. These results have important
implications for health professionals seeking simple but effective strategies that can be widely delivered via e-health
technology to reduce blood pressure, however, large-scale controlled trials are needed.
THANK YOU