Investigating the Effect of Progressive Muscle Relaxation on the Level of Anxiety and Vital Signs of Hospitalized Elderly

EXTENDED ABSTRACT

Background

Anxiety is a frequent psychological problem in older age and may be intensified by chronic disease, reduced independence, hospitalization, and concern about medical procedures and outcomes. In hospitalized older adults, anxiety can activate the sympathetic nervous system and contribute to changes in heart rate, respiratory rate, and blood pressure, with possible adverse effects on recovery and well-being [1–5]. Pharmacological treatment is not always an ideal first approach for anxiety in this population because therapeutic effects may be delayed and adverse effects, dependence, withdrawal reactions, drug interactions, dizziness, fatigue, and cognitive problems can be clinically important [6, 7]. Consequently, low-cost complementary interventions have received increasing attention. Relaxation techniques, including progressive muscle relaxation (PMR), are designed to reduce physiological arousal by alternating deliberate muscle contraction with release and may be applicable across age groups [8–12]. Previous studies cited in the article reported benefits of relaxation-based interventions for quality of life and psychological symptoms in older adults and other clinical populations [13, 14]. However, the effect of PMR on both anxiety and repeated vital-sign measurements among hospitalized older adults had not been adequately evaluated. The present randomized clinical trial therefore examined whether PMR could reduce anxiety and favorably change vital signs in older patients admitted to hospital wards in Kalaleh, Iran.

Methods

This two-group, single-blind randomized clinical trial was conducted among older adults hospitalized at Rasool Akram Hospital in Kalaleh in 2022, excluding patients admitted to the intensive care unit or coronary care unit. Eligible participants were aged 60 years or older, had at least mild anxiety at study entry, provided consent, and had no unstable chronic disease, major neurologic impairment, limiting musculoskeletal disorder, severe sensory or cognitive disability, previously diagnosed psychiatric disorder, or other medical limitation preventing participation. Patients using anti-anxiety medication before admission, those hospitalized for surgery or complementary treatments, and individuals meeting the prespecified exclusion criteria during the study were not retained. Based on the planned power calculation and allowance for attrition, 38 participants were assigned to each group, giving a total sample of 76. Block randomization with block sizes of four to six was generated using Excel, and the trained research assistant responsible for questionnaires and vital-sign measurements remained unaware of group allocation. Anxiety was assessed with the 21-item Beck Anxiety Inventory, scored from 0 to 63; the instrument and its Persian psychometric properties were described using the cited validation literature [16–18]. Systolic and diastolic blood pressure, heart rate, and respiratory rate were measured with standardized procedures and calibrated equipment. Anxiety was measured before the study and at the end of the third intervention day. Vital signs were recorded in morning and evening sessions over three consecutive days. The control group received routine care only. In the intervention group, PMR was performed on the bed in a 30-degree semi-sitting position twice daily, at approximately 10:00-11:00 and 17:00-18:00, for three consecutive days. Participants were guided to contract each muscle group for 5 seconds and then relax it for 10 seconds, proceeding sequentially through the upper limbs, facial muscles, neck and shoulders, trunk, buttocks, thighs, and lower legs, followed by approximately 2 minutes of relaxed deep breathing. Each session lasted about 20 minutes, and vital signs were reassessed 20 minutes afterward. Data were analyzed in SPSS version 22 using an intention-to-treat approach. Depending on distribution and comparison type, independent or paired t tests, Mann-Whitney or Wilcoxon tests, chi-square tests, and mixed analysis of variance for repeated measurements were used. The study was approved by the North Khorasan University of Medical Sciences ethics committee (IR.NKUMS.REC.1401.022) and registered in the Iranian Registry of Clinical Trials (IRCT20220813055677N1).

Results

Most participants were women (83.33%). Mean age was 69.94 years in the control group and 72.5 years in the intervention group. The groups were comparable at baseline with respect to demographic variables, mean anxiety, and mean vital signs (P>0.05). After three consecutive days, the between-group difference in mean anxiety was not statistically significant (P=0.067). Nevertheless, the within-group analysis showed a statistically significant reduction in anxiety in the intervention group (P=0.001), whereas the control-group change was not significant (P=0.08). Table 1 reproduces the source article values exactly as printed. Repeated vital-sign measurements demonstrated a different temporal pattern between groups. Systolic blood pressure in the control group showed a generally regular upward trend with relatively small changes, whereas the intervention group showed a generally downward trend with larger changes. Diastolic pressure fluctuated irregularly in controls but tended to decrease in the intervention group. Heart rate decreased slightly over time in controls and more markedly in the intervention group. Respiratory rate also showed a small downward change in controls and a larger downward trend in the intervention group. In the point-by-point comparisons reported by the authors, systolic blood pressure on the afternoon of day 3 after the intervention differed significantly between groups (P=0.012), and respiratory rate on the afternoon of day 1 after the intervention was also significantly different (P=0.049). The original article figures show these longitudinal patterns for systolic blood pressure, heart rate, and respiratory rate.

Table 1. Within-group and between-group anxiety values before and after the intervention.

Figure 1. Changes in mean systolic blood pressure scores between the control and intervention groups.

Figure 2. Changes in mean heart rate scores between the control and intervention groups.

Figure 3. Changes in mean respiratory rate scores between the control and intervention groups.

Conclusion

Progressive muscle relaxation produced clinically favorable downward changes in vital-sign trajectories and a significant within-group reduction in anxiety among hospitalized older adults, although the post-intervention anxiety difference between the intervention and control groups did not reach statistical significance. The findings support PMR as a simple, inexpensive, nonpharmacological approach that can be incorporated into routine care when clinically appropriate, particularly for management of physiological arousal and anxiety-related symptoms. Interpretation should remain consistent with the study limitations: the sample was relatively small, participants were drawn from general hospital wards in one setting, and the intervention lasted only three days. The authors therefore noted that larger studies, longer intervention periods, and inclusion of older adults from different hospital wards would be useful for evaluating the durability and generalizability of the observed effects.

Keywords: Aged, Anxiety, Autogenic training, Vital signs

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