COMPARATIVE ANALYSIS OF THE EFFECTIVENESS OF RELAXATION TECHNIQUES AND PHYSICAL EXERCISE ON CONTROLLED BLOOD PRESSURE: A META-ANALYSIS

Wahidin ‎; Dina Raidanti; Cristin Jayanti; Didin Syaefudin; Rina Wijayanti

doi:10.37430/jen.v9i1.350

COMPARATIVE ANALYSIS OF THE EFFECTIVENESS OF RELAXATION TECHNIQUES AND PHYSICAL EXERCISE ON CONTROLLED BLOOD PRESSURE: A META-ANALYSIS

Wahidin ‎, Dina Raidanti, Cristin Jayanti, Didin Syaefudin, Rina Wijayanti

Abstract

Background: Hypertension is a major global public health problem, with prevalence increasing, particularly among adults and older adults. Non-pharmacological interventions such as relaxation techniques and physical exercise are widely recommended for blood pressure control. However, evidence directly comparing the relative effectiveness of these two approaches remains limited and inconsistent. Objective: This study aimed to compare the efficacy of relaxation techniques and physical exercise in reducing blood pressure using a meta-analytic approach. Methods: This meta-analysis was conducted in accordance with PRISMA 2020 guidelines. Randomized controlled trials and quasi-experimental studies evaluating relaxation techniques or physical exercise interventions on blood pressure outcomes were included. Statistical analyses were performed using a random-effects model with standardized mean difference (SMD) as the effect size metric. Heterogeneity and subgroup analyses by age group and intervention type were conducted. Results: A total of 33 studies were included in the analysis. Overall, non-pharmacological interventions significantly reduced blood pressure (SMD = −0.744; p < 0.001). Subgroup analysis showed that relaxation techniques produced a greater reduction in blood pressure (SMD = −0.954) than physical exercise (SMD = −0.570). The largest effect size was observed among older adults (SMD = −1.075). Substantial heterogeneity was identified across studies (I² = 74.1%). Conclusion: Both relaxation techniques and physical exercise are effective non-pharmacological interventions for reducing blood pressure, with relaxation techniques demonstrating greater and more consistent effects, particularly among older adults. These findings provide robust comparative evidence to support evidence-based hypertension management strategies.

Keywords

Hypertension; Older adults; Relaxation techniques; Physical exercise; Meta-analysis

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References

REFERENCES

S. L. James et al., “Global, regional, and national incidence, prevalence, and years lived with disability for 354 Diseases and Injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017,” Lancet, vol. 392, no. 10159, pp. 1789–1858, 2018, doi: 10.1016/S0140-6736(18)32279-7.

M. Naghavi et al., “Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016,” Lancet, vol. 390, no. 10100, pp. 1151–1210, 2017, doi: 10.1016/S0140-6736(17)32152-9.

T. Marthias et al., “Impact of non-communicable disease multimorbidity on health service use, catastrophic health expenditure and productivity loss in Indonesia: A population-based panel data analysis study,” BMJ Open, vol. 11, no. 2, 2021, doi: 10.1136/bmjopen-2020-041870.

N. C. D. Countdown, “NCD Countdown 2030: pathways to achieving Sustainable Development Goal target 3.4,” The Lancet, vol. 396, no. 10255, pp. 918–934, 2020, doi: 10.1016/S0140-6736(20)31761-X.

G. Too et al., “Timing and Risk Factors of Postpartum Stroke,” Obstet. Gynecol., vol. 131, no. 1, pp. 70–78, 2018, doi: 10.1097/AOG.0000000000002372.

T. Promsrisuk et al., “Therapeutic Effects of Slow Deep Breathing on Cardiopulmonary Function, Physical Performance, Biochemical Parameters, and Stress in Older Adult Patients with Long COVID in Phayao, Thailand,” Ann. Geriatr. Med. Res., vol. 29, no. 2, pp. 240–253, 2025, doi: 10.4235/agmr.24.0175.

T. Borzoo et al., “The effect of aromatherapy and music therapy on blood pressure and heart rate of nursing students before taking the exam,” Sci. Rep., vol. 15, no. 1, pp. 1–7, 2025, doi: 10.1038/s41598-025-97199-6.

E. Eguchi, N. Funakubo, K. Tomooka, T. Ohira, K. Ogino, and T. Tanigawa, “The effects of aroma foot massage on blood pressure and anxiety in Japanese community-dwelling men and women: A crossover randomized controlled trial,” PLoS One, vol. 11, no. 3, pp. 1–13, 2016, doi: 10.1371/journal.pone.0151712.

N. P. Widari and U. P. Erika, “Teknik relaksasi autogenik dan relaksasi otot progresif terhadap tekanan darah pada lansia dengan hipertensi,” Ilmu Keperawatan Respati, vol. 4, no. 2, pp. 68–79, 2018.

T. T. Yeh and Y. C. Ho, “Immediate effects of structured and natural deep breathing on heart rate variability and blood pressure in community-dwelling older adults,” Exp. Gerontol., vol. 198, no. November, p. 112644, 2024, doi: 10.1016/j.exger.2024.112644.

M. Mahdavi-Roshan et al., “The effects of rice bran oil on left ventricular systolic function, cardiometabolic risk factors and inflammatory mediators in men with coronary artery disease: A randomized clinical trial,” Food Funct., vol. 12, no. 10, pp. 4446–4457, 2021, doi: 10.1039/d1fo00094b.

I. Wulan Purnamasari and I. Wahyudi, “Intervention of Slow Stroke Back Massage (SSBM) Therapy at the Garut For Hypertensive Elderly,” Nurs. Case Insight J., vol. 3, no. 1, pp. 26–29, 2025, doi: 10.63166/81x4kp29.

X. Li et al., “Effect of Tai Chi vs Aerobic Exercise on Blood Pressure in Patients With Prehypertension: A Randomized Clinical Trial,” JAMA Netw. Open, vol. 7, no. 2, p. E2354937, 2024, doi: 10.1001/jamanetworkopen. 2023.54937.

O. M. Ballut, “The Impact of Non-Pharmacological Interventions on Blood Pressure Control in Patients With Hypertension: A Systematic Review,” Cureus, 2023, doi: 10.7759/cureus. 48444.

V. A. Cornelissen and N. A. Smart, “Exercise training for blood pressure: a systematic review and meta-analysis.” J. Am. Heart Assoc., vol. 2, no. 1, pp. 1–9, 2013, doi: 10.1161/JAHA.112.004473.

M. Borenstein, L. V Hedges, J. P. T. Higgins, and H. R. Rothstein, Introduction to Meta-Analysis. 2009.

T. C. Sepdianto, S. Suprajitno, and M. D. Ciptaning Tyas, “Effectiveness of Effleurage Back Massage and Slow Deep Breathing on Vital Signs in Hypertension Patients,” Heal. Gate, vol. 2, no. 2, pp. 189–195, 2024, doi: 10.70111/hg2204.

G. A. M. D. D. Meidayanti, S. A. K. Candrawati, and N. K. Y. Lestari, “The Effect of Slow Stroke Back Massage on Blood Pressure in Elderly Patients with Hypertension,” Holist. Nurs. Heal. Sci., vol. 6, no. 1, pp. 30–37, 2023, doi: 10.14710/hnhs. 6.1.2023.30-37.

R. Oktalina, S. Anwar, and S. Badriah, “Effectiveness of Combination Acupressure Therapy and Murotal Al-Qur’an to Reduce Blood Pressure of the Elderly,” J. Penelit. Pendidik. IPA, vol. 10, no. Special Issue, pp. 390–395, 2024, doi: 10.29303/jppipa.v10ispecialissue.8619.

M. A. Hafid, “The Effectiveness of Progressive Muscle Relaxation Therapy and Guided Imagery Techniques for Reducing Blood Pressure in Hypertension Patients,” Open Access Maced. J. Med. Sci., vol. 10, no. G, pp. 689–693, 2022, doi: 10.3889/oamjms. 2022.9806.

Z. Zulkarnaini, D. Febriana, and A. Ardilla, “Efektivitas Slow Deep Breathing terhadap Penurunan Tekanan Darah pada Lansia Penderita Hipertensi Primer,” Holist. Nurs. Heal. Sci., vol. 8, no. 1, pp. 14–22, 2025, doi: 10.14710/hnhs. 8.1.2025.14-22.

C. Amaliah and M. Sutarno, “Perbandingan Efektivitas Massage Musculus Trapezius dengan Aromaterapi Mawar Terhadap Perubahan Tekanan Darah Pada Ibu Hamil di Puskesmas Pondok Gede Kota Bekasi,” Malahayati Nurs. J., vol. 6, no. 4, pp. 1701–1715, 2024, doi: 10.33024/mnj.v6i4.11210.

A. Babak, N. Motamedi, S. Z. Mousavi, and N. Ghasemi, “Effects of Mindfulness-Based Stress Reduction on Blood Pressure, Mental Health, and Quality of Life in Hypertensive Adult Women: A Randomized Clinical Trial Study,” J. Tehran Univ. Hear. Cent., vol. 17, no. 3, pp. 127–133, 2022, doi: 10.18502/jthc.v17i3.10845.

S. I. Yoon et al., “Effectiveness of Mindfulness and Qigong Training for Self-Healing in patients with Hwabyung and depressive disorder: a randomized controlled trial,” Front. Psychiatry, vol. 16, no. June, pp. 1–15, 2025, doi: 10.3389/fpsyt. 2025.1508937.

R. Elliya, S. Baharuddin, and D. Hermawan, “Pengaruh terapi musik klasik (mozart) terhadap tekanan darah pada lansia dengan hipertensi,” Holistik J. Kesehat., vol. 15, no. 1, pp. 158–165, 2021, doi: 10.33024/hjk.v15i1.1605.

Y. A. Majid, “Pengaruh Terapi Relaksasi Guided Imagery Terhadap Tekanan Darah Pada Lansia Penderita Hipertensi,” Masker Med., vol. 9, no. 2, pp. 542–550, 2022, doi: 10.52523/maskermedika.v9i2.468.

I. A. Mir, A. T. John, S. Humayra, Q. I. Khan, T. F. Chong, and H. A. Manan, “Effect of mindfulness-based meditation on blood pressure among adults with elevated blood pressure and hypertension: A systematic review of randomized controlled trials,” Complement. Ther. Med., vol. 85, no. January, p. 103084, 2024, doi: 10.1016/j.ctim.2024.103084.

M. P. Rodrigues et al., “Efficacy of an Educational Intervention for Sodium Restriction in Patients with Hypertension: A Randomized Controlled Trial,” Nutrients, vol. 15, no. 9, 2023, doi: 10.3390/nu15092159.

L. Saptharishi et al., “Community-based Randomized Controlled Trial of Non-pharmacological Interventions in Prevention and Control of Hypertension among Young Adults,” Indian J. Community Med., vol. 34, no. 4, pp. 329–334, Oct. 2009, doi: 10.4103/0970-0218.58393.

C. Sarinukul, T. Janyacharoen, W. Donpunha, S. Nakmareong, W. Ruksapukdee, and K. Sawanyawisuth, “The Effects of Stepping Exercise on Blood Pressure, Physical Performance, and Quality of Life in Female Older Adults with Stage 1 Hypertension: a Randomized Controlled Trial,” Can. Geriatr. J., vol. 26, no. 1, pp. 144–149, 2023, doi: 10.5770/cgj. 26.632.

I. López-Ruiz, F. Lozano, M. D. Masia, and N. González-Gálvez, “Multicomponent Training and Optimal Dosing Strategies for Adults with Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” Sports, vol. 11, no. 6, 2023, doi: 10.3390/sports11060115.

D. L. Cohen, S. Boudhar, A. Bowler, and R. R. Townsend, “Blood Pressure Effects of Yoga, Alone or in Combination With Lifestyle Measures: Results of the Lifestyle Modification and Blood Pressure Study (LIMBS),” J. Clin. Hypertens., vol. 18, no. 8, pp. 809–816, 2016, doi: 10.1111/jch. 12772.

W. Zhang, H. Wang, Z. Xiong, and C. Li, “Efficacy of Tai Chi exercise in patients with hypertension: systematic review and meta-analysis,” Curr. Probl. Cardiol., vol. 49, no. 11, p. 102798, 2024, doi: 10.1016/j.cpcardiol.2024.102798.

Hans Selye, The Stress of Life, Revised ed. New York: The McGraw-Hill Companies, Inc., New York, 1984.

M. H. Whaley, “ACSM’s Guidelines for Exercise Testing and Prescription, 7th Edition,” Am. Coll. Sport Med., vol. 73, no. 2, pp. 51–51, 2018, doi: 10.1002/wea. 3086.

S. Blair et al., Guidelines for Exercise Testing and Prescription, Fourth Edition, vol. 23, no. 10. 1991. doi: 10.1249/00005768-199110000-00024.

J. Olsen and M. J. Baisch, “An integrative review of information systems and terminologies used in local health departments,” J. Am. Med. Informatics Assoc., vol. 21, no. E2, 2014, doi: 10.1136/amiajnl-2013-001714.

H. Cramer, “The Efficacy and Safety of Yoga in Managing Hypertension,” Exp. Clin. Endocrinol. Diabetes, vol. 124, no. 2, pp. 65–70, 2015, doi: 10.1055/s-0035-1565062.

N. Afiani, I. Nurmala, U. Negeri, J. Timur, U. Airlangga, and J. Timur, “Lansia Berdaya Tekanan Darah Terkendali : Peningkatan Kemampuan Manajemen Diri Pada Penderita Hipertensi,” LINK, vol. 21, no. 2, pp. 152–160, 2025, doi: 10.31983/link.v21i2.14095.

P. I. W. L. Putu Indah Sintya Dewi, Made Mahaguna Putra, Aditha Angga Pratama, “Latihan Fisik Intensitas Tinggi Menurunkan Tekanan Darah,” Ilm. Keperawatan, vol. 32, no. 3, pp. 167–186, 2022.

D. Ratna Sari and R. Palupi, “Pengaruh Latihan Fisik Brisk Walking Terhadap Tekanan Darah pada Penderita Hipertensi di Wilayah Kerja Puskesmas Punggur,” Heal. Res. J. Indones., vol. 2, no. 3, pp. 191–200, 2024, doi: 10.63004/hrji.v2i3.323.

J. Polónia and R. Marques Pereira, “Guidelines-based therapeutic strategies for controlling hypertension in non-controlled hypertensive patients followed by family physicians in primary health care in Portugal: the GPHT-PT study,” Blood Press., vol. 33, no. 1, p., 2024, doi: 10.1080/08037051.2024.2345887.

DOI: https://doi.org/10.37430/jen.v9i1.350