title: Association of multimodal treatment-induced improvements in stress, exercise volume, nutrition, and weight with improved blood pressure in severely obese women.
abstract: BACKGROUND
  Research suggests that obesity, physical inactivity, anxiety (psychological tension), and a poor diet are associated with high blood pressure (BP). Although medication is the treatment of choice, behavioral methods might also improve BP in individuals with both prehypertension and hypertension.
  
  
  METHODS
  Severely obese women from the southeast USA (N = 155; M(age) = 45 years; M(body mass index) (BMI) = 41 kg/m(2)) that fulfilled criteria for either prehypertension (n = 96) or hypertension (n = 59) volunteered for a Young Men's Christian Association-based exercise and nutrition support treatment that also included instruction in stress-management methods.
  
  
  RESULTS
  Significant (p values of ≤0.001) within-group improvements over 26 weeks in tension, overall mood, exercise volume, fruit and vegetable consumption, BMI, and systolic and diastolic BP were found. There were significant (p values of <0.05) bivariate correlations between improvements in tension, overall mood, volume of exercise, fruit and vegetable intake, BMI, and systolic and diastolic BP improvements. Multiple regression analyses, separately entering changes in tension and overall mood along with changes in volume of exercise, fruit and vegetable intake, and BMI, explained 19 and 20 % of the variances in systolic BP, respectively, (p values of <0.001) and 8 % of the variances, each (p values of ≤0.02), in diastolic BP. In each multiple regression equation, improvements in the psychological factors of tension and overall mood demonstrated the greatest independent contribution to the variances accounted for in BP improvements.
  
  
  CONCLUSIONS
  The ability of nonpharmaceutical, behavioral methods to improve BP in women with prehypertension and hypertension was suggested, with changes in the psychological factors of tension and overall mood appearing to be especially salient. Practical applications of findings were suggested.
authors.affiliation: YMCA of Metropolitan Atlanta, 100 Edgewood Avenue, NE, Suite 1100, Atlanta, GA, USA, jamesa@ymcaatlanta.org.
authors.forename: James J
authors.initials: JJ
authors.lastname: Annesi
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001823:Body Composition / Q000502:physiology; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003376:Counseling; D015444:Exercise / Q000502:physiology / Q000523:psychology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D018529:Nutritional Support; D009765:Obesity / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D058246:Prehypertension / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000469:parasitology / Q000503:physiopathology / Q000628:therapy*