Self Care Pharmacy Blog

Posts Tagged ‘exercise’


Strike a Pose to Lower Your Blood Pressure

Monday, November 23rd, 2015
Image courtesy of arztsamui at

Image courtesy of arztsamui at

By Kathrine Distel, PharmD Student Cedarville University School of Pharmacy

Hypertension or, as it is more commonly known, high blood pressure, is a chronic disorder that is becoming increasingly prevalent. It can be caused by a number of different factors, including a sedentary lifestyle, poor sleep habits, food choice and smoking. The most common treatment for high blood pressure is medication geared toward lowering blood pressure along with a suggestion to make some lifestyle changes. Unfortunately, those changes—namely diet and exercise—are unappealing at best to most people. Few people want to drastically alter their eating habits and rearrange their schedule so they can go to the gym every other day. Fortunately, there are plenty of other options that are emerging as effective ways to lower blood pressure without endlessly circling a track. One such option, yoga, has been in practice for many years.

Many people balk at the idea of doing yoga because it brings to mind impressive flexibility, leggings, and a room full of yoga mats. However, that doesn’t have to be the case. Thanks to the internet, you can pick a yoga instructor who moves at your pace in the privacy of your living room, avoiding all of the unappealing aspects of the exercise. A study1 conducted in India, a country that has been practicing yoga for centuries, found that regular yoga combined with blood pressure medications can produce significant decreases in blood pressure.

Study participants were divided into two groups. The first group, the control, continued to take their blood pressure medications as they had been with no changes besides instructions to avoid smoking, alcohol and any medications that may interfere with the study. The second group, besides the same set of instructions, began practicing yoga with trained yoga therapists three times a week. The sessions were about 45 minutes long and included preparatory practices, static postures, pranayama—exercises that focus on breathing control—and relaxation techniques. Participants were also encouraged to practice what they had learned throughout the rest of the week. 1

The study lasted for 12 weeks and, while the control group had no significant changes from its original measurements, the group practicing yoga showed some interesting results. When compared with both their own original measurements and the end results of the control group, the group practicing yoga had a significant decrease of both components of blood pressure (p < 0.05)—systolic and diastolic pressures— as well as mean arterial pressure (MAP) (p < 0.001). MAP is influenced by several different components, including blood pressure, heart rate, how much blood the heart is pumping every minute, and how much resistance the blood vessels are offering to the heart. When these values are low, the heart doesn’t have to work as hard and risks such as heart attack and stroke are decreased.1

There were two main limitations to this study. The sample size—70 people split evenly between the two groups—was a small one. Additionally, the study only lasted 12 weeks which did not allow it to assess the long-term effects of yoga on high blood pressure. However, other studies2-7 have also found yoga to have positive effects on blood pressure. One systematic review6 of 32 articles found that yoga could lower blood pressure in both healthy and hypertensive patients. Another study5, a year-long study in Hong Kong consisting of 182 participants, found that regular yoga practice could lead to decreased blood pressure, resting heart rate and waist circumference.

When the exercises for these studies were designed, the instructors kept in mind the group they would be teaching. The exercises were geared toward beginners and seniors. One case study, 7 which used resources such as a DVD and a YouTube video, evaluated the effectiveness of a modified chair yoga. This program increased safety for participants with decreased mobility or balance while still effectively lowering blood pressure. Participants also reported decreased anxiety and joint pain.

Results of systematic reviews3,6,8 have been mixed on the effects of yoga. Many, but not all of the trials found positive effects on blood pressure, some of those results were statistically significant while others were not. With so many varying results, there is still more research that needs to be done to determine a true measure of the effect of yoga on blood pressure.It is important to note that, because research into the effects of yoga on blood pressure is still relatively new, this practice has not yet been shown be effective in replacing blood pressure medications. Rather, it works well in conjunction with those medications.

So if your doctor has recommended a lifestyle change to aid in controlling your blood pressure, yoga may be a great place for you to begin. There are many free resources available, ranging from DVDs at the library to videos on YouTube, and it doesn’t require any equipment besides an open floor and perhaps a chair.

What do you think? Will you try yoga to assist in controlling your blood pressure?



1. Pushpanathan P, Trakroo M, RP S, Madhavan C. Heart rate variability by poincaré plot analysis in patients of essential hypertension and 12-week yoga therapy. National Journal of Physiology, Pharmacy & Pharmacology. 2015;5(3):174-180.

2. Centre for Reviews aD. Yoga and hypertension: A systematic review (provisional abstract). Altern Ther Health Med. 2014:32-59.

3. Cramer H, Haller H, Lauche R, Steckhan N, Michalsen A, Dobos G. A systematic review and meta-analysis of yoga for hypertension. Am J Hypertens. 2014;27(9):1146-1151.

4. Hagins M, Rundle A, Consedine NS, Khalsa SBS. A randomized controlled trial comparing the effects of yoga with an active control on ambulatory blood pressure in individuals with prehypertension and stage 1 hypertension. J Clin Hypertens (Greenwich). 2014;16(1):54-62.

5. Siu PM, Yu AP, Benzie IF, Woo J. Effects of 1-year yoga on cardiovascular risk factors in middle-aged and older adults with metabolic syndrome: A randomized trial. Diabetology & Metabolic Syndrome. 2015;7(1):1-12.

6. Yang K. A review of yoga programs for four leading risk factors of chronic diseases. Evidence-based Complementary & Alternative Medicine (eCAM). 2007;4(4):487-491.

7. Awdish R, Small B, Cajigas H. Development of a modified yoga program for pulmonary hypertension: A case series. Altern Ther Health Med. 2015;21(2):48-52.

8. Centre for Reviews aD. Yoga for hypertension: A systematic review of randomized clinical trials (provisional abstract). Complement Ther Med. 2014:511-522.

Exercise to Improve Back Pain

Tuesday, November 26th, 2013

By Gina Mattes, PharmD Student Cedarville University

Today almost 80% of  Americans have back pain, but often the treatments used are ineffective and costly. 1 However, there is another way that people can relieve back pain that is relatively cheap or free and you can do it right at home! Exercise is being proven to be more beneficial for your heart, but it’s also better for pain.1 In an article posted in The New York Times a study was cited that showed even going for a walk every day can help reduce back pain.1 This conclusion was made because there was no statistical difference between the exercise group and the walking group with significant improvement in walking distance from the beginning to the end in both groups.2 The six minute walk test was the main outcome for the study.  Both groups participated in a six-week program that was twice a week. Both groups started with 20 minutes during each session and increased by 5 minutes every week. The walking group spent time on a treadmill starting at a low intensity, increasing intensity, then had a cool down with low intensity at each session. The exercise group focused on active movement and strengthening exercises, beginning with a five minute warm up, low loaded exercise increasing the number of exercise repetitions over the course of the 6 weeks, and a five minute cool-down.2


Another way to reduce chronic pain The New York Times article proposes is doing yoga. One study showed that yoga for short-term effectiveness helped tremendously, but only moderate outcomes for long-term effectiveness.3 The reason exercise has been helping rather than hurting is because you are strengthening the muscles in your back and abdomen, in doing this you are able to regain function of your back without pain because of the endurance your body has built up.2 In the study presented by the Clinical Journal of Pain Cramer and colleagues looked at 10 randomized clinical studies that collectively had 967 chronic back pain patients that showed strong evidence for short term relief and moderate evidence for long-term relief.3 There is no simple solution or usually a reason for back pain to be occurring, but even if there is no reason for the pain people don’t have to be in pain instead they can go for a walk and build up those muscles. I agree with this article. It’s easier and way cheaper to go outside and walk around the block a few times, going to the gym, or looking up youtube yoga videos to do some yoga and help yourself than taking medications that probably won’t help in the long run.

Studies have show that the standard of care for lower back pain such as steroid shots, has often  been ineffective for chronic pain. 3, 4 Additional evidence shows that people doing yoga to relieve chronic back pain is much more helpful.1,2,3  In a study done by Saper he came up with a 12 week hatha yoga program.5 The study included a 12 week yoga program with each session lasting about 75 minutes, led by a 2 year yoga expert.5 The program was broken up into four, three week segments with each week containing a different theme.5 The participants were strongly encouraged to practice yoga for 30 minutes each day, the participants were given all material needed to practice at home.5 Improvement was evaluated by questionnaires that participants filled out at 6 and 12 weeks of intervention.5 At the end the study showed that participants’ pain decreased resulting in the decrease of using pain medications and muscle relaxants.5 However, the study did have a high number of drop out rates and a low number of follow up at 26 weeks.5 Even with the issues of the study it still shows a significant difference in people who did a yoga program versus the people who did not.5

The increase in studies that exercise in some form helps chronic pain patients long-term are overwhelming. Even a short day trip in a study done in Japan where people went to an amusement park for the day had pain relief, but the relief quickly faded after that day.2,3 This study included several age groups and measured back pain at different times (10 minutes, 1 hour,and 3 hours after arriving), but had a low number of participants in the study making it more questionable.3 In light of this new evidence I would highly recommend to my patients to try and build those lower back and abdomen muscles by going for a walk or maybe even looking up a few easy exercises online instead of jumping to steroid shots. In the end walking around the block would likely be more beneficial to health holistically than medication therapy.

So which would you rather have, going for a walk every day or sitting in the doctor’s office waiting for a shot that may not have long term effectiveness?


1. Reynolds, G. Alternatives for back pain relief. The New York Times. July 18, 2013:MM18. October 21, 2013

2.   Shnayderman I, Katz-Leurer M. An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomized controlled trial. Clinical Rehabilitation [serial online]. March 2013;27(3):207-214.

3.   Centre for Reviews and D. A systematic review and meta‐analysis of yoga for low back pain (Provisional abstract). Clinical Journal Of Pain [serial online]. 2013;:450-460.

4.   Staal J, Nelemans P, de Bie R. Spinal injection therapy for low back pain. JAMA: The Journal Of The American Medical Association [serial online]. June 19, 2013;309(23):2439-2440.

5.   Saper R. Yoga for Chronic Low Back Pain in a Predominantly Minority Population: A Pilot Randomized Controlled Trial. Alternative Therapies In Health & Medicine [serial online]. November 2009;15(6):18-27.

6.   Sakakibara T, Wang Z, Kasai Y. Does going to an amusement park alleviate low back pain? A preliminary study. Journal Of Pain Research [serial online]. January 1, 2012;5:409-413.