The impact of health literacy on adherence to isometric exercise and its effect on blood pressure in hypertensive patients

Authors

  • Bangu Bangu Department of Health Promotion, Faculty of College of Science and Technology, University of Sembilanbelas November Kolaka, Kolaka, Indonesia
  • Heriviyatno Julika Siagian Medical Surgical Nursing, Faculty of College of Science and Technology, University of Sembilanbelas November Kolaka, Kolaka, Indonesia
  • La Ode Alifariki Department of Nursing, Faculty of Medical, University of Halu Oleo, Kendari, Indonesia

DOI:

https://doi.org/10.47197/retos.v73.117675

Keywords:

Hypertension, health literacy, isometric exercise, blood pressure, patient adherence

Abstract

Background: Hypertension is a major global health problem and a leading cause of cardiovascular disease.

Objective: This study aimed to analyze the influence of health literacy on adherence to isometric exercise and its effects on blood pressure reduction among patients with hypertension in Kolaka.

Methods: A quasi-experimental study with a pretest–posttest control group design. Sixty respondents diagnosed with hypertension were randomly selected using simple random sampling and divided into two groups: 30 with higher health literacy and 30 with lower health literacy, as measured by the Health Literacy Questionnaire (HLQ). Blood pressure was measured before and after the intervention using a standardized digital sphygmomanometer. Data were analyzed using paired t-tests and ANCOVA with a significance level of p < 0.05, and Cohen’s d was calculated to determine the magnitude of the intervention effect.

Results: The intervention group experienced a significant decrease in systolic blood pressure from 152.1 ± 9.0 to 141.3 ± 7.5 mmHg and in diastolic pressure from 95.2 ± 6.5 to 87.1 ± 5.8 mmHg (both p < 0.001; large effect sizes). In contrast, the control group showed no significant changes in either systolic or diastolic pressure (p > 0.05). ANCOVA revealed that health literacy significantly influenced reductions in both systolic (p = 0.014) and diastolic (p = 0.017) blood pressure, with a significant interaction between literacy level and exercise adherence (p < 0.05).

Conclusion: Health literacy plays a crucial role in enhancing the effectiveness of isometric exercise in lowering blood pressure among hypertensive patients. Patients with higher literacy demonstrated greater adherence and achieved better blood pressure control.

References

Almeida, J. P. A. de S., Bessa, M., Lopes, L. T. P., Goncalves, A., Roever, L., & Zanetti, H. R. (2021). Isometric handgrip exercise training reduces resting systolic blood pressure but does not interfere with diastolic blood pressure and heart rate variability in hypertensive subjects: a systematic review and meta-analysis of randomized clinical trials. Hypertension Research, 44(9), 1205–1212. doi: 10.1038/s41440-021-00681-7

Bozorgi, A., Hosseini, H., Eftekhar, H., Majdzadeh, R., Yoonessi, A., Ramezankhani, A., Mansouri, M., & Ashoorkhani, M. (2021). The effect of the mobile “blood pressure management application” on hypertension self-management enhancement: a randomized controlled trial. Trials, 22(1), 413. https://doi.org/10.1186/s13063-021-05270-0

Carey, R. M., Moran, A. E., & Whelton, P. K. (2022). Treatment of hypertension: a review. Jama, 328(18), 1849-1861. doi: 10.1001/jama.2022.19590.

Clifford, C., Challoumas, D., Paul, L., Syme, G., & Millar, N. L. (2020). Effectiveness of isometric exercise in the management of tendinopathy: a systematic review and meta-analysis of randomised trials. BMJ Open Sport & Exercise Medicine, 6(1), e000760. doi: 10.1136/bmjsem-2020-000760.

Coneglian, J. C., T Barcelos, G., Bandeira, A. C. N., Carvalho, A. C. A., Correia, M. A., Farah, B. Q., Ritti-Dias, R. M., & Gerage, A. M. (2023). Acute blood pressure response to different types of isometric exercise: a systematic review with meta-analysis. Reviews in Cardiovascular Medicine, 24(2), 60. doi: 10.31083/j.rcm2402060.

Cortes-Chacón, J., Magaña Chávez, G. E., Flores Olivares, L. A., Peña-Vázquez, O., Quintana-Mendias, E., Cervantes Hernandez, N., & Enriquez-del Castillo, L. A. (2025). Efectividad de los protocolos de ejercicio en adultos con hipertensión: metaanálisis actualizado de ensayos clínicos. Retos, 70, 517-532. https://doi.org/10.47197/retos.v70.113302

Dinas Kesehatan Provinsi Sulawesi Tenggara. (2022). Profil Kesehatan Propinsi Sulawesi Tenggara. Bidang P2PL Dinas Kesehatan Prov. Sultra. https://pusdatin.kemkes.go.id/index.php?category=profil-kesehatan-kabupaten&provid=PV-027

dos Santos Alves, M. C., Castoldi, R. C., Marcelo, H. I., Aleixo, P. H., de Araujo Furtado, A. E. R., Ribeiro, D. A. F., Sotão, S. S., Gambassi, B. B., & Almeida, F. de J. F. (2025). Effect of Isometric Exercise on the Blood Pressure of Hypertensive Older Adults. Journal of Health Sciences, 27(1), 15-18. PMID: 40438518; PMC12106110. doi: 10.21037/atm-24-124

Edwards, J. J., Wiles, J., & O’Driscoll, J. (2022). Mechanisms for blood pressure reduction following isometric exercise training: a systematic review and meta-analysis. Journal of Hypertension, 40(11), 2299–2306. doi: 10.1097/HJH.0000000000003261

Karami, M., Ashtarian, H., Rajati, M., Hamzeh, B., & Rajati, F. (2023). The effect of health literacy intervention on adherence to medication of uncontrolled hypertensive patients using the M-health. BMC Medical Informatics and Decision Making, 23(1), 289. doi: 10.1186/s12911-023-02393-z

Kemenkes. (2023). Laporan Riskesdas 2023. April 2024. https://www.badankebijakan.kemkes.go.id/laporan-hasil-survei/

Kim, H.-L. (2023). Arterial stiffness and hypertension. Clinical Hypertension, 29(1), 31. doi: 10.1186/s40885-023-00258-1

Königstein, K., Dipla, K., & Zafeiridis, A. (2023). Training the vessels: molecular and clinical effects of exercise on vascular health a narrative review. Cells, 12(21), 2544. doi: 10.3390/cells12212544

Mega, J. Y. (2024). Empowering Health: Unveiling the Impact of Self-Efficacy and Lifestyle on Hypertension Management. Journal of Current Health Sciences, 4(1), 9–16. doi: 10.47679/jchs.202460

Melizza, N., & Putri, I. M. (2022). Studi literatur: efektivitas intervensi isometric handgrip exercise untuk menurunkan tekanan darah pada lansia dengan hipertensi. Indonesian Health Science Journal, 2(1). https://doi.org/10.52298/ihsj.v2i1.23

Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews Nephrology, 16(4), 223–237. https://doi.org/10.1038/s41581-019-0244-2

Naseri, M. B. A. (2024). Isometric Exercise for Blood Pressure and Endothelial Function in Metabolic Syndrome: A Review. Asian Journal of Sports Medicine, 15(4). https://doi.org/10.5812/asjsm-153619

Oliveira, P. C., Silva, M. R., Lehnen, A. M., & Waclawovsky, G. (2023). Isometric handgrip training, but not a single session, reduces blood pressure in individuals with hypertension: a systematic review and meta-analysis. Journal of Human Hypertension, 37(9), 844–853. doi: 10.1038/s41371-022-00778-7

Paakkari, L., & Okan, O. (2019). Health literacy—talking the language of (school) education. HLRP: Health Literacy Research and Practice, 3(3), e161–e164. https://doi.org/10.3928/24748307-20190502-01

Reis, C. B. F., Gasparini-Neto, V. H., de Miranda, L. R. A., Neves, L. N. S., Iglesias-Soler, E., de Sousa, N. M. F., Carletti, L., & Leite, R. D. (2025). Impact of set configurations on hemodynamics, cardiac autonomic, and metabolic responses. Retos, 68, 1937–1947. https://doi.org/10.47197/retos.v68.113869

Rueda, Z. R. R., Barrios, A. J. G., Jaramillo, L. Y. G., Flórez, A. G. J., Hortúa, A. M. J., & Delgado, J. C. S. (2025). Evaluación de la modulación autonómica cardiovascular durante la sentadilla isométrica de pared en personas post revascularización miocárdica o percutánea. Retos, 69, 1419–1426. https://doi.org/10.47197/retos.v69.115349

Song, Y., Jia, H., Hua, Y., Wu, C., Li, S., Li, K., Liang, Z., & Wang, Y. (2022). The molecular mechanism of aerobic exercise improving vascular remodeling in hypertension. Frontiers in Physiology, 13, 792292. doi: 10.3389/fphys.2022.792292

Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., Brand, H., & European, (HLS-EU) Consortium Health Literacy Project. (2012). Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health, 12, 1–13. doi:10.1186/1471-2458-12-80

Sudayasa, I. P., Alifariki, L. O., Rahmawati, Hafizah, I., Jamaludin, Milasari, N., Nisda, & Usman, A. N. (2020). Determinant Juvenile Blood Pressure Factors in Coastal Areas of Sampara District in Southeast Sulawesi. Enfermeria Clinica, 30(Supplement 2), 585-588. https://doi.org/10.1016/j.enfcli.2019.07.167

Sudayasa, I. P., Husdaningsih, F., & Alifariki, L. O. (2023). Polymorphism of Gene ACE I/D and Family History of Hypertension as Predisposition of Hypertension. Malaysian Journal of Medicine & Health Sciences, 19(3). https://doi.org/10.47836/mjmhs.19.2.34

Suriyawong, W., & Pipatpiboon, N. (2022). Social cognitive theory-based interventions on healthy lifestyles for hypertensive patients: a systematic review. CMU J Nat Sci, 21(3), e2022040. https://doi.org/10.12982/CMUJNS.2022.040

World Health Organization. (2025). Hypertension. 25 September 2025. https://www.who.int/news-room/fact-sheets/detail/hypertension

Zhang, Q., Huang, F., Zhang, L., Li, S., & Zhang, J. (2021). The effect of high blood pressure-health literacy, self-management behavior, self-efficacy and social support on the health-related quality of life of Kazakh hypertension patients in a low-income rural area of China: a structural equation model. BMC Public Health, 21(1), 1114. doi: 10.1186/s12889-021-11129-5

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Published

17-10-2025

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Section

Original Research Article

How to Cite

Bangu, B., Siagian, H. J., & Alifariki, L. O. (2025). The impact of health literacy on adherence to isometric exercise and its effect on blood pressure in hypertensive patients. Retos, 73, 883-892. https://doi.org/10.47197/retos.v73.117675