Effect of Isometric Exercise versus Hand Reflexology on Fatigue among Patients with Acute Myocardial Infarction: A Randomized Clinical Trial
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Objective: This study aimed to compare the effectiveness of isometric exercise versus hand reflexology on hemodynamic parameters and anxiety in patients with acute myocardial infarction (AMI).
Methods and Materials: A parallel-group randomized controlled design was used. A total of 88 participants were randomly allocated to three groups: the isometric exercise group (n = 26), the hand reflexology group (n = 29), and the control group (n = 33). Patients with AMI underwent a 25- to 30-minute isometric exercise session and a 10-minute hand reflexology session for 3 consecutive days. Demographic data and clinical variables were collected. Participants' anxiety was assessed in the three groups using the STAI scale, with three pretests and posttests. Data were analyzed using SPSS v26 and a parametric one-way ANOVA (Analysis of Variance) test, as well as non-parametric tests (Mann-Whitney U, Kruskal-Wallis, and Spearman correlation).
Findings: A statistically significant difference between the groups was reported in terms of all hemodynamic parameters (P < 0.001) after applying isometric exercise and hand reflexology. Also, a statistically significant difference between the groups was reported in relation to anxiety (P < 0.001).
Conclusion: The researchers concluded that isometric exercise and hand reflexology improve hemodynamic parameters significantly and reduce anxiety levels in patients with AMI. Therefore, nurses can use this easy, non-pharmacological, non-invasive, and low-cost method.
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Abbaszadeh, Y., Allahbakhshian, A., Seyyedrasooli, A., Sarbakhsh, P., Goljarian, S., & Safaei, N. (2018). Effects of foot reflexology on anxiety and physiological parameters in patients undergoing coronary artery bypass graft surgery: A clinical trial. Complementary Therapies in Clinical Practice, 31, 220-228. https://doi.org/10.1016/j.ctcp.2018.02.018
Ahmad, E., Tiwari, A., & Kumar, A. (2020). Cardiovascular diseases (CVDs) detection using machine learning algorithms. Int. J. Res. Appl. Sci. Eng, 8, 2341-2346. https://doi.org/10.22214/ijraset.2020.6376
AL-Mussawi, G. A., & Baqer, M. (2024). Effect of Aromatherapy on Pain Intensity for Patients Undergoing Arterial Sheath Removal after Percutaneous Coronary Intervention: A Randomized Controlled Trial. Pakistan Journal of Life & Social Sciences, 22(1). https://doi.org/10.57239/PJLSS-2024-22.1.0096
Al-zuhairy, M. R., & Al-Jubouri, M. B. (2024). Awareness of Patients Toward Warning Signs of Heart Attacks. Pakistan Journal of Life and Social Sciences, 22(1), 1437-1449. https://doi.org/10.57239/PJLSS-2024-22.1.0097
Albadry, N. H. A., & Hassen, H. S. (2024). Effectiveness of Chest Pain Nursing Management on the Satisfaction of Patients with Angina in Emergency Unit. Iraqi National Journal of Nursing Specialties, 37(1), 122-131.
Ali, E. A., Awad, W. H. A., Khedr, M. A., & Rabie, E. A. E. G. A. (2023). Effect of hand reflexology in ameliorating anxiety, pain, and fatigue among patients undergoing coronary angiography. BMC complementary medicine and therapies, 23(1), 425. https://doi.org/10.1186/s12906-023-04256-6
Amini, M., Zayeri, F., & Salehi, M. (2021). Trend analysis of cardiovascular disease mortality, incidence, and mortality-to-incidence ratio: results from global burden of disease study 2017. BMC public health, 21(1), 401. https://doi.org/10.1186/s12889-021-10429-0
Amiri, A. A., Karvandian, K., Amiri, A. A., & Zeinali, A. (2020). Anxiety in the operating room before elective surgery. Acta Medica Iranica. https://doi.org/10.18502/acta.v58i4.3920
Bahammam, M. A. (2016). Validity and reliability of an Arabic version of the state-trait anxiety inventory in a Saudi dental setting. Saudi medical journal, 37(6), 668. https://doi.org/10.15537/smj.2016.6.13935
Barbosa, R. M., Dos Santos, A. C. N., do Sacramento, M. d. S., Dos Santos, C. P. C., Souza, P. E. S., Santana, U. S., & Petto, J. (2025). Effect of isometric resistance exercise on blood pressure in normotensive adults: a systematic review of randomized clinical trials. Annals of translational medicine, 13(2), 16. https://doi.org/10.21037/atm-24-124
Byrne, R. A., Rossello, X., Coughlan, J., Barbato, E., Berry, C., Chieffo, A., Claeys, M. J., Dan, G.-A., Dweck, M. R., & Galbraith, M. (2024). 2023 ESC guidelines for the management of acute coronary syndromes: developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal: Acute Cardiovascular Care, 13(1), 55-161. https://doi.org/10.1093/ehjacc/zuad156
Ebadi, A., Kavei, P., Moradian, S. T., & Saeid, Y. (2015). The effect of foot reflexology on physiologic parameters and mechanical ventilation weaning time in patients undergoing open-heart surgery: A clinical trial study. Complementary Therapies in Clinical Practice, 21(3), 188-192. https://doi.org/10.1016/j.ctcp.2015.07.001
Elsayed, A. E., Kandeel, N. A., & Abd El-Aziz, W. W. (2019). The effect of foot reflexology on physiological indicators and mechanical ventilation weaning time among open-heart surgery patients. Am J Nurs Res, 7(4), 412-419. https://doi.org/10.12691/ajnr-7-4-2
Faleh, J. N., & AL-Fayyadh, S. (2022). Preoperative Incentive Spirometer to Prevent Postoperative Pulmonary Complications following Open Heart Surgeries: A Randomized Single Blinded Multi-Centric Clinical Trial. Journal of Contemporary Medical Sciences, 8(4). https://doi.org/10.22317/jcms.v8i4.1261
Ferede, Y. A., Bizuneh, Y. B., Workie, M. M., & Admass, B. A. (2022). “Prevalence and associated factors of preoperative anxiety among obstetric patients who underwent cesarean section”: a cross-sectional study. Annals of Medicine and Surgery, 74, 103272. https://doi.org/10.1016/j.amsu.2022.103272
Gao, Z., Chen, Z., Sun, A., & Deng, X. (2019). Gender differences in cardiovascular disease. Medicine in Novel Technology and Devices, 4, 100025. https://doi.org/10.1016/j.medntd.2019.100025
Gheorghe, A., Griffiths, U., Murphy, A., Legido-Quigley, H., Lamptey, P., & Perel, P. (2018). The economic burden of cardiovascular disease and hypertension in low-and middle-income countries: a systematic review. BMC public health, 18(1), 975. https://doi.org/10.1186/s12889-018-5806-x
Golitaleb, M., Safdari, A., Rafiei, F., Yaghoobzadeh, A., Mohamadi, N., & Mokhtari, R. (2025). Comparing the impact of foot and hand reflexology on anxiety and physiological indices in colonoscopy candidates: A randomized clinical trial. Contemporary Clinical Trials Communications, 44, 101449. https://doi.org/10.1016/j.conctc.2025.101449
Gu, G., Zhou, Y., Zhang, Y., & Cui, W. (2016). Increased prevalence of anxiety and depression symptoms in patients with coronary artery disease before and after percutaneous coronary intervention treatment. BMC psychiatry, 16(1), 259. https://doi.org/10.1186/s12888-016-0972-9
Harshini, S. S., Sridevi, G., & Preetha, S. (2021). Effect of sustained isometric and isotonic exercises on blood pressure and heart rate variability–a comparative study. Journal of Pharmaceutical Research International, 33(47B), 908-915. https://doi.org/10.9734/jpri/2021/v33i47B33204
Heidaranlu, E., Goyaghaj, N. S., Moradi, A., & Ebadi, A. (2021). The efficacy of an intervention program for pain intensity reduction in patients undergoing arterial sheath removal after coronary artery angioplasty. The Journal of Tehran University Heart Center, 16(3), 102. https://doi.org/10.18502/jthc.v16i3.8186
Isam, S. R., & Hassan, H. S. (2023). Effectiveness of Cardiac Rehabilitation Instructional Program on Knowledge and Health-related Quality of Life for Patients Undergone Coronary Artery Bypass Graft Surgery. Iraqi National Journal of Nursing Specialties, 36(1), 59-70. https://doi.org/10.58897/injns.v36i1.809
Jasim, A. H., Majeed, H. M., & Mohammed, T. R. (2020). Knowledge and protective health behaviors concerning risk factors for coronary heart disease among Baghdad University students. Medico Legal Update, 20(2), 234-239. https://doi.org/10.37506/mlu.v20i2.1108
Kandemir, D., & Oztekin, S. D. (2019). How effective is reflexology on physiological parameters and weaning time from mechanical ventilation in patients undergoing cardiovascular surgery? European Journal of Integrative Medicine, 26, 43-49. https://doi.org/10.1016/j.eujim.2019.01.008
Kardan, M., Zarei, B., BahramiTaghanaki, H., Vagharseyyedin, S. A., & Azdaki, N. (2020). The effects of foot reflexology on back pain after coronary angiography: a randomized controlled trial. Complementary Therapies in Clinical Practice, 38, 101068. https://doi.org/10.1016/j.ctcp.2019.101068
Khaledifar, A., Nasiri, M., Khaledifar, B., Khaledifar, A., & Mokhtari, A. (2017). The effect of reflexotherapy and massage therapy on vital signs and stress before coronary angiography: An open-label clinical trial. ARYA atherosclerosis, 13(2), 50. https://pmc.ncbi.nlm.nih.gov/articles/PMC5628851/
Khalili, A., Alavi, N. M., Mardani, D., Pour, N. B., Paymard, A., Daraei, M., Yaripoor, S., Bashiri, S., & Vardanjani, M. M. (2016). The effect of foot reflexology on physiological parameters. Int J Med Res Health Sci, 5(9), 50-54. DOI: 10.1016/j.ctcp.2015.07.001
Khan, J. S., Hah, J. M., & Mackey, S. C. (2019). Effects of smoking on patients with chronic pain: a propensity-weighted analysis on the Collaborative Health Outcomes Information Registry. Pain, 160(10), 2374-2379. https://doi.org/10.1097/j.pain.0000000000001631
Mansour, K. A., Al-Sarraf, M. F., & Najm, M. A. (2019). Health Status among Patients with Percutaneous Coronary Intervention at Cardiac Centers in Baghdad city. Scopus IJPHRD Citation Score, 10(01), 827. https://doi.org/10.5958/0976-5506.2019.00162.1
Moeini, M., Kahangi, L. S., Valiani, M., & Heshmat, R. (2011). The effect of reflexotherapy on patients’ vital signs before coronary artery bypass graft surgery. Iranian Journal of Nursing and Midwifery Research, 16(1), 8. https://pmc.ncbi.nlm.nih.gov/articles/PMC3203304/
Mousa, A. M., & Mansour, K. (2020). Effectiveness of an instructional program concerning healthy lifestyle on patients’ attitudes after percutaneous coronary intervention at cardiac centers in Baghdad city. Iraqi National Journal of Nursing Specialties, 33(1), 1-11. https://doi.org/10.58897/injns.v33i1.396
Naghavi, M., Ong, K. L., Aali, A., Ababneh, H. S., Abate, Y. H., Abbafati, C., Abbasgholizadeh, R., Abbasian, M., Abbasi-Kangevari, M., & Abbastabar, H. (2024). Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet, 403(10440), 2100-2132. https://doi.org/10.1016/S0140-6736(24)00367-2
Omar, B., Ahmed, N. H., & Farhad, D. D. (2021). Patients’ Knowledge Regarding Cardiac Catheterization at Cardiac Specialty Hospital in Slemani City of Iraq: A Descriptive Study. https://doi.org/10.55349/ijmsnr.2021112228
Pasyar, N., Rambod, M., Najafian, Z., Nikoo, M. H., Yoosefinejad, A. K., & Salmanpour, M. (2024). The effect of foot reflexology on fatigue, sleep quality, physiological indices, and electrocardiogram changes in patients with acute myocardial infarction: a randomized clinical trial. Iranian Journal of Nursing and Midwifery Research, 29(5), 608-616. https://doi.org/10.4103/ijnmr.ijnmr_310_23
Patel, T., Khamar, Z., & Patel, K. (2022). Effect of Aerobic Versus Isometric Exercise Training on Blood Pressure in Young Pre-Hypertensive Individuals. DOI: https://doi.org/10.52403/ijhsr.20220746
Rahmani Vasokolaei, Z., Rejeh, N., Heravi-Karimooi, M., Tadrisi, S. D., Saatchi, K., Poshtchaman, Z., Sieloff, C., & Vaismoradi, M. (2019). Comparison of the effects of hand reflexology versus acupressure on anxiety and vital signs in female patients with coronary artery diseases. Healthcare, https://doi.org/10.3390/healthcare7010026
Rambod, M., Pasyar, N., & Shamsadini, M. (2019). The effect of foot reflexology on fatigue, pain, and sleep quality in lymphoma patients: a clinical trial. European Journal of Oncology Nursing, 43, 101678. https://doi.org/10.1016/j.ejon.2019.101678
Rambod, M., Rakhshan, M., Tohidinik, S., & Nikoo, M. H. (2020). The effect of lemon inhalation aromatherapy on blood pressure, electrocardiogram changes, and anxiety in acute myocardial infarction patients: A clinical, multi-centered, assessor-blinded trial design. Complementary Therapies in Clinical Practice, 39, 101155. https://doi.org/10.1016/j.ctcp.2020.101155
Salman, F. K., & Salman, M. W. (2024). Assessment of Warfarin Therapy Knowledge among Patients with Cardiovascular Disease. Iraqi National Journal of Nursing Specialties, 37(1), 95-102. https://doi.org/10.58897/3yrahp76
Sayari, S., Nobahar, M., & Ghorbani, R. (2021). Effect of foot reflexology on chest pain and anxiety in patients with acute myocardial infarction: A double blind randomized clinical trial. Complementary Therapies in Clinical Practice, 42, 101296. https://doi.org/10.1016/j.ctcp.2020.101296
Shakoor, E., Motamedi, P., Banaee, F., JaaFari, N., & Sylvain, C. (2025). Effect of 10-week Isometric handgrip exercise at home on hemodynamic and psychological factors of sedentary hypertensive women during COVID-19: A randomized controlled trial. Journal of Human Sport and Exercise, 20(1), 22-38. https://doi.org/10.55860/m1tqbv39
Shu, T., Tang, M., He, B., Liu, X., Han, Y., Liu, C., Jose, P. A., Wang, H., Zhang, Q.-W., & Zeng, C. (2024). Assessing global, regional, and national time trends and associated risk factors of the mortality in ischemic heart disease through global burden of disease 2019 study: population-based study. JMIR public health and surveillance, 10(1), e46821. https://doi.org/10.2196/46821
Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P., & Jacobs, G. (1983). Consulting psychologists press. Palo Alto, CA, 19831983. https://markdejesus.com/the-ocd-healing-journey-book/?gad_source=1&gad_campaignid=20740993864&gbraid=0AAAAAqXS1jfHEz3pS26rzE_ajGv1i1xp2&gclid=CjwKCAjwjtTNBhB0EiwAuswYhjmQ2p32ZfbtkOGyPA682_nCXcvgYjvRPAiWhNB7inDbCJx4LdFVAhoCvg4QAvD_BwE
Thygesen, K., Alpert, J. S., White, H. D., Jaffe, A. S., Apple, F. S., Galvani, M., Katus, H. A., Newby, L. K., Ravkilde, J., & Chaitman, B. (2007). Universal definition of myocardial infarction: Kristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the joint ESC/ACCF/AHA/WHF task force for the redefinition of myocardial infarction. European heart journal, 28(20), 2525-2538. https://doi.org/10.1093/eurheartj/ehm355
Vaduganathan, M., Mensah, G. A., Turco, J. V., Fuster, V., & Roth, G. A. (2022). The global burden of cardiovascular diseases and risk: a compass for future health. In (Vol. 80, pp. 2361-2371): American College of Cardiology Foundation Washington DC. https://doi.org/10.1016/j.jacc.2022.11.005
Vardanjani, M. M., Alavi, N. M., Razavi, N. S., Aghajani, M., Azizi-Fini, E., & Vaghefi, S. M. (2013). A randomized-controlled trial examining the effects of reflexology on anxiety of patients undergoing coronary angiography. Nursing and midwifery studies, 2(3), 3. https://doi.org/10.5812/nms.12167
Vogel, B., Acevedo, M., Appelman, Y., Merz, C. N. B., Chieffo, A., Figtree, G. A., Guerrero, M., Kunadian, V., Lam, C. S., & Maas, A. H. (2021). The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. The Lancet, 397(10292), 2385-2438. https://doi.org/10.1016/S0140-6736(21)00684-X
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