Effect of music therapy versus aromatherapy with aerobic exercise on stage 2 hypertension: A randomized controlled trial

Santosh Metgud; Divya Mahadevan; Venicia D'Souza; Elly Dourado

doi:10.4103/ijptr.ijptr_35_22

ORIGINAL ARTICLE

Year : 2023 | Volume : 5 | Issue : 1 | Page : 46-50

Effect of music therapy versus aromatherapy with aerobic exercise on stage 2 hypertension: A randomized controlled trial

Santosh Metgud, Divya Mahadevan, Venicia D'Souza, Elly Dourado
Department of Orthopedic Manual Therapy, KLE Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Submission	26-Mar-2022
Date of Decision	08-Jun-2022
Date of Acceptance	20-Jul-2023
Date of Web Publication	11-Aug-2023

Correspondence Address:
Dr. Santosh Metgud
KLE Institute of Physiotherapy, Nehru Nagar, Belagavi - 590 010, Karnataka
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijptr.ijptr_35_22

Abstract

Context: High blood pressure (BP) is a worldwide public health problem that is becoming more common by the day. Music therapy and aromatherapy are two novel complementary therapies, that when used in conjunction with aerobic exercise, can help lower BP. The outcome is measured using a mercury sphygmomanometer and the Perceived Stress Scale (PSS).
Aim: The aim of this study was to determine the effect of music therapy versus aromatherapy in combination with aerobic exercise in stage 2 hypertensive patients.
Settings and Design: The present randomized controlled trial was conducted in Tertiary Care Centre, Belagavi.
Subjects and Methods: A total of 78 people with stage 2 hypertension were included in the study. For 2 weeks, the patients were randomly assigned to receive either music therapy or aromatherapy in combination with aerobic exercise or merely aerobic exercise. The PSS was given to the participants before and after the intervention, and their BP was monitored with a mercury sphygmomanometer before and after the intervention.
Statistical Analysis: Various statistical measures such as test of significance, SD, and mean were used to analyze the data.
Results: The results were statistically significant (P = 0.0001). The percentage of change seen in systolic BP (SBP) scores in Group A was 1.60, Group B was 3.44, and Group C was 1.57. The percentage of change seen in the diastolic BP (DBP) scores in Group A was 1.17, Group B was 2.81, and Group C was 1.48. The percentage of change seen in the PSS scores in Group A was 14.51, Group B was 22.17, and Group C was 16.47.
Conclusion: The present study concluded that combining music therapy and aerobic exercise showed a maximum reduction in SBP, DBP, and stress levels. Thus, music therapy with aerobic exercise can be used as an alternative treatment with medications to reduce BP in hypertensive patients.

Keywords: Aerobic exercise, Aromatherapy, Hypertension, Music therapy

How to cite this article:
Metgud S, Mahadevan D, D'Souza V, Dourado E. Effect of music therapy versus aromatherapy with aerobic exercise on stage 2 hypertension: A randomized controlled trial. Indian J Phys Ther Res 2023;5:46-50

How to cite this URL:
Metgud S, Mahadevan D, D'Souza V, Dourado E. Effect of music therapy versus aromatherapy with aerobic exercise on stage 2 hypertension: A randomized controlled trial. Indian J Phys Ther Res [serial online] 2023 [cited 2023 Oct 1];5:46-50. Available from: https://www.ijptr.org/text.asp?2023/5/1/46/383677

Introduction

Hypertension is a disease in which the systolic blood pressure (SBP) rises to 140 mmHg and diastolic blood pressure (DBP) to 90 mmHg.^[1] Any action that utilizes vast muscle groups and is rhythmic is classified as aerobic exercise.^[2] Physical activity decreases BP when done regularly.^[3] Music therapy is a type of allied health practice that employs music and helps in the healing process.^[4] Music has the ability to reduce BP.^[5] Aromatherapy refers to the use of plant-derived essential oils.^[6] Common essential oils for treating high BP are ylang-ylang, lavender, helichrysum, lemon, and marjoram.^[7]

Subjects and Methods

Community-dwelling individuals of Belagavi city, who were clinically diagnosed with stage 2 hypertension, were a part of this study.

The duration of data collection lasted from December 1, 2021, to January 31, 2022 with sample size of 78 (26 subjects in each group).

Inclusion criteria

The criteria for inclusion were: the study comprised males and females who had stage 2 hypertension (chronic) and the ones within the age group of 40–55 years. Participants with a score in the range of 14–26 on the Perceived Stress Scale (PSS) and those who were minimally active on the International Physical Activity Questionnaire were included in the study.

Exclusion criteria

The following were the criteria for exclusion: participants with any systemic illnesses like diabetes mellitus were excluded. Furthermore, those participants who have an allergy to fragrances, difficulty in hearing, history of lower limb injuries, musculoskeletal problems, or fractures in the past 6 months were excluded from this study

Ethical approval

The study was approved by the Institutional Ethical Review Committee, Belgaum. Ethical review number 686.

Procedure

The Institutional Ethics Committee approved the procedure, and all necessary precautions against COVID-19 infection were taken in accordance with the ICMR recommendations. The target demographic was community-dwelling people who were prediagnosed with stage 2 hypertension by a physician and who were between the ages of 40 and 55 years. Participants were given information about the study's goal and procedure. All consenting participants signed a written informed consent form and gave demographic information. The authors of the current study completed substantial research on how to perform aromatherapy but were not licensed. The outcome measures used in the present study are BP measurements pre- and postintervention. BP of the participant was first measured before the intervention and then after 2 weeks. The other outcome measure used is the PSS. The PSS is a reliable and valid tool. The PSS helps us in understanding how different situations affect our feelings and our perceived stress. The questions in this scale ask about your feelings and thoughts.

Intervention

All participants were assigned to one of three groups randomly using chit method:

Group A: aerobic exercise was offered to the Group A participants.

Walking is an aerobic exercise
For 2 weeks, 3 days a week was the frequency
20 min in length.

Group B: music therapy and aerobic exercise were offered to the Group B participants.

For 2 weeks, 3 days a week was the frequency
There will be no noise in the room where the intervention will take place
For 15 min, the instrumental music of Peter Sterling's “The Angels Gift” will be performed
Following that, the patients were given the identical aerobic exercise as Group A.

Group C: aromatherapy and aerobic exercise were offered to the Group C participants.

For 2 weeks, 3 days a week was the frequency.

There were four types of oils used:

Lavender (No. 1) (linalool 25%–38%, linalyl acetate 25%–34%, and camphor 0.5%–1%).
Ylang-Ylang (Ylang-Ylang) (benzyl acetate, linalool, p-cresyl methyl ether, and methyl benzoate).
Oregano (terpinene-4-ol 21.2% and trans-sabinene hydrate 15.5%).
Neroli (linalool 28.5%, linalyl acetate 19.6%, and nerolidol 9.1%).

All of the oils were combined in a 20:15:10:2 ratio, kept cold, and then diffused into the air with a light so that the participants could inhale the odorants. The participants were instructed to inhale the odorants for 20 min.

Following that, the individuals were given aerobic exercise in the same manner as Group A.

Statistical analysis

To validate the results, SPSS version 23 (Armonk, Newyork, USA) was utilized to conduct the analysis for this study. Data were entered into a Microsoft Excel sheet, tabulated, and statistically analyzed. Various statistical measures such as test of significance, SD, and mean were used to analyze the data.

Results

[Table 1] shows that 78 participants were recruited in the study, 33 were male and 45 were female, accounting for 34.62% of males belonging to Group A, 46.15% to Group B, and 46.15% to Group C. Among females, 65.38% belong to Group A, 53.85% belong to Group B, and 53.85% belong to Group C. The participant's average age was between 48.07 years in Group A, 48.23 years in Group B, and 47.96 years in Group C, having a mean height of 157.96 cm in Group A, 162.76 cm in Group B, and 163.15 cm in Group C, while the mean weight was 64.0 kg in Group A, 73.88 kg in Group B, and 69.65 kg in Group C, and the body mass index was 25.25 in Group A, 27.58 in Group B, and 26.21 in Group C.

Table 1: Comparison of Group A, Group B, and Group C with the mean age, height, weight, and body mass index by one-way ANOVA

Click here to view

[Table 2] shows that the preintervention SBP score in Group A was 146.85, Group B was 149.62, and Group C was 149.35. The postintervention mean SBP score in Group A was 144.50, Group B was 144.46, and Group C was 147. The difference between pre- and postintervention scores in Group A versus Group B and Group B versus C shows statistical significance with P = 0.0001. No statistical significance was found in Group A versus C.

Table 2: Comparison of Group A, Group B, and Group C with the mean of pre- and postintervention systolic blood pressure scores by one-way ANOVA

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[Table 3] shows that the preintervention mean DBP score in Group A was 89.00, Group B was 90.31, and Group C was 88.39. The postintervention mean DBP score in Group A was 87.96, Group B was 87.77, and Group C was 87.08. The distinction between before and after intervention scores in Group A versus B and Group B versus C shows statistical significance with P = 0.0119 and 0.0472, respectively. No statistical significance was found in Group A versus C.

Table 3: Comparison of Group A, Group B, and Group C with the mean of preintervention and postintervention diastolic blood pressure scores by one-way ANOVA

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[Table 4] shows that the preintervention mean PSS score in Group A was 22.27, Group B was 24.12, and Group C was 22.89. The postintervention mean PSS score in Group A was 19.04, Group B was 18.77, and Group C was 19.12. The distinction between before and after intervention scores in Group A versus B and Group B versus C shows statistical significance with P = 0.0001. No statistical significance was found in Group A versus C.

Table 4: Comparison of Group A, Group B, and Group C with the mean of pre- and postintervention Perceived Stress Scale scores by one-way ANOVA

Click here to view

Discussion

Our research is the largest of its kind to compare music therapy and aromatherapy with aerobic exercise. In two aspects, it varies from the past research. To begin with, this is the first study to compare music therapy and aromatherapy. Second, aerobic exercise is included as an additional therapy in both groups.

The current study is the first prospective randomized controlled trial in stage 2 hypertension that compares the effects of music therapy against aromatherapy with aerobic exercise. The main findings of this study are that music therapy with aerobic exercise is effective in lowering BP in patients with stage 2 hypertension.

The way music modulates BP still remains imprecise. Music has a variety of mechanisms for lowering BP. Listening to music provides physical and mental relaxation in general. Listening to music causes the release of endorphins and a sense of well-being by generating a psychological reaction in the limbic system. After listening to music, plasma catecholamine and plasma renin activity drop, explaining the decrease in sympathetic tone that affects the heart rate and BP.^[8] The quick rise in energy requirements during aerobic activity necessitates equally rapid circulatory modifications to satisfy the increased need for oxygen and nutrients, as well as to remove metabolic end products such as carbon dioxide, water, and lactic acid, and to dissipate excess heat. A synchronized action of all of the body's systems: neuromuscular, respiratory, cardiovascular, metabolic, and hormonal, results in a shift in body metabolism. Adequate blood flow and cellular respiration are required for oxygen transport and consumption by the mitochondria of contracting muscle.^[9] In aromatherapy, essential oils can enter the body through the system of olfaction or the skin. Numerous investigations have discovered that olfactory stimulation alters physiological indicators such as BP, muscle tension, and heart rate immediately.^[6]

Because nonpharmacological interventions can help lower BP, the current study compared pre- and postintervention SBP, DBP, and PSS scores. Both the pre- and postintervention SBP and DBP scores analyses consistently demonstrated that aerobic exercise with music therapy resulted in a substantial drop in BP, with P = 0.0001. Aromatherapy combined with aerobic exercise had no statistical impact in lowering BP.

Supap Im-oun's instrumental music had a potential antihypertensive effect, lowering both home and workplace SBP by 9.5 and 11 mmHg, respectively, and both home and office DBP by 6 mmHg.^[8] In November 2009, Claudia Regina de Oliveira published a controlled clinical experiment that found that music therapy helped hypertension patients improve their quality of life and BP control.^[10] Imtiyaz Ali's latest experiment in 2021 found that music therapy lowered SBP and HR considerably, suggesting that it could be a potential technique for preventing the progression of prehypertension to hypertension.^[11] Peter Sterling's “The Angels Gift” music and aerobic exercise were found to be considerably beneficial in lowering BP in the current study.^[12]

In a study led by Nikolaos Pagonas, aerobic exercise, even when done in an uncontrolled and unsupervised manner, resulted in a significant drop in ambulatory and office BP.^[13] In 2012, Fernando Dimeo's randomized controlled trial demonstrated that regular exercise should lower exercise BP, increase athletic performance, and be included in therapeutic approaches to resistant hypertension, as measured by peak oxygen uptake and lactate curves.

A study done by Hwang in Korea showed that inhalation of oils helped in lowering BP in clients with essential hypertension. Similarly, in the present study, aromatherapy is found to be effective in reducing BP in stage 2 hypertension.^[14] There is less information about the effects of aromatherapy. In the current research, aromatherapy combined with aerobic exercise was not effective in reducing BP.

First, the age limit of the participants was within 40–55 years. Second, the intervention lasted for only 2 weeks. Third, the study's sample size was small. Finally, the study was limited to the participants who did not have any musculoskeletal problems, lower limb injuries, or fractures in the past 6 months, allergy to fragrances, and difficulty in hearing. Future studies on combined therapies can be carried out in stage 1 hypertension.

Conclusion

The present study concluded that music therapy combined with aerobic exercise showed a maximum reduction in SBP and DBP and also a decrease in stress levels. The participants in the study did not report any side effects during the period of the study. Thus, music therapy combined with aerobic exercise can be used as an alternative treatment with pharmacological treatment to achieve BP reduction in hypertensive patients.

Acknowledgment

We are grateful to the Head of the institution for granting us permission to conduct the study and use the research-related infrastructure. We are thankful to all the individuals for participating in the study, without whom the study would not have been possible.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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