Comparative Effects of Improved Cardiorespiratory Fitness, Stress, and Weight on Blood Pressure in a Community-Based Treatment: Implications for Physician Referral

Introduction: The efficacy of behavioral treatments for elevated blood pressure (BP) is unclear, and the relative effectiveness of improvements in common intervention targets such as cardiorespiratory fitness, stress, and body weight requires clarification. Aims of this research were to assess the effectiveness of a community-based, health behaviorchange program for improving resting heart rate, weight, and stress; and to clarify associations of their changes with BP changes. Methods: A group of 140 women with severe obesity volunteered for a YMCA-based treatment for weight loss incorporating exercise, nutrition, and stress management methods. Physiological and psychological measurements were obtained at baseline and month 6. Results: The treatment was associated with significant within-group improvements in resting heart rate, tension, weight, and systolic and diastolic BP (all P values <0.01). The moderate effect sizes for BP change (d = 0.37 and 0.58, respectively) were comparable with more invasive and expensive behavioral treatments. Significant linear bivariate relationships were found between changes in resting heart rate, tension (stress), and weight, and systolic and diastolic BP changes. When simultaneously entered into multiple regression equations, the variance accounted for in systolic and diastolic BP (R = 0.17 and 0.06, respectively) was significant. In each equation, only changes in tension significantly contributed independently to the explained variances in BP changes. Conclusions: Along with improvements in fitness and weight, managing stress appears to be especially important for reducing BP. The present community-based treatment may be a viable option for physician referral as either an alternate or adjunct to medications.