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Impact of Transcendental Meditation
1
on cardiovascular function at rest
and during acute stress in adolescents with high normal blood pressure
Vernon A. Barnes
a,
*, Frank A. Treiber
a,b
, Harry Davis
c
a
Department of Pediatrics, Georgia Institute for Prevention of Human Diseases and Accidents, Building HS1640,
Medical College of Georgia, Augusta, GA 30912, USA
b
Department of Psychiatry, Medical College of Georgia, Augusta, GA 30912, USA
c
Office of Biostatistics, Medical College of Georgia, Augusta, GA 30912, USA
Received 22 November 2000; accepted 22 June 2001
Abstract
Objective: This study examined the impact of the Tran-
scendental Meditation (TM) program on cardiovascular (CV)
reactivity in adolescents with high normal blood pressure (BP).
Method: Thirty-five adolescents [34 African Americans (AAs),
1 Caucasian American (CA); ages 15 –18 years] with resting
systolic blood pressure (SBP) between the 85th and 95th
percentile for their age and gender on three consecutive
occasions, were randomly assigned to either TM (n= 17) or
health education control (CTL, n= 18) groups. The TM group
engaged in 15-min meditation twice each day for 2 months
including sessions during school lunch break. Primary CV
outcome measures were changes in BP, heart rate (HR), and
cardiac output (CO) at rest and in response to two laboratory
stressors, a simulated car driving stressor and an interpersonal
social stressor interview. Results: The TM group exhibited
greater decreases in resting SBP ( P< .03) from pre- to post-
intervention, compared to the CTL group. The TM group
exhibited greater decreases from pre- to postintervention in
SBP, HR, and CO reactivity ( P’s < .03) to the simulated car
driving stressor, and in SBP reactivity ( P< .03) to the social
stressor interview. Conclusion: The TM program appears to have
a beneficial impact upon CV functioning at rest and during acute
laboratory stress in adolescents at-risk for hypertension. D2001
Elsevier Science Inc. All rights reserved.
Keywords: Transcendental Meditation; Blood pressure; Stress response; Adolescents; Cardiovascular reactivity
Introduction
Essential hypertension (EH) remains a significant health
problem in the US with approximately 40 to 50 million
persons affected [1]. Epidemiological studies have shown
that blood pressure (BP) percentile ranking relative to age
mates tends to track from late childhood through adoles-
cence into adulthood [2,3]. Teenagers with high normal BP
are at increased risk for development of EH as young adults
[4– 7]. From late childhood onward, African Americans
(AAs) exhibit higher casual BP than Caucasian Americans
(CAs) [8]. Thus, AA youth with high normal BP are at
particular risk for EH [8,9].
Although the relationship between cardiovascular react-
ivity (CVR) and EH has been controversial, exaggerated
CVR to stress has been hypothesized as contributing to the
early etiology of EH [10 – 12]. Exaggerated CVR to labor-
atory stressors has been shown to predict future EH in adults
[13– 15], and change in BP levels and left ventricular mass
1 to 6 years later in youth [16– 21]. It has been hypothesized
that the high prevalence of EH among AAs is in part due to
their greater exposure to chronic environmental stress
related to sociostructural barriers (e.g., racism, inadequate
economic resources) [11,22–24]. Similar to adult findings
[22,25– 27], AA youth often exhibit greater BP reactivity to
stress than CA youth, and the underlying hemodynamic
mechanism frequently responsible is increased total peri-
pheral resistance (TPR) [17,28 – 30].
Few studies have examined whether stress reduction
methods reduce casual BP in youth with high normal BP,
and the results of those studies are mixed. Ewart et al. [31]
0022-3999/01/$ – see front matter D2001 Elsevier Science Inc. All rights reserved.
PII: S0022-3999(01)00261-6
* Corresponding author. Tel.: +1-706-721-2195; fax: +1-706-721-
7150.
E-mail address: vbarnes@mail.mcg.edu (V.A. Barnes).
Journal of Psychosomatic Research 51 (2001) 597 – 605
examined the efficacy of progressive muscle relaxation
(PMR) training in teenagers with BP above the 85th percent-
ile. PMR instruction provided in class for 3 months reduced
the systolic blood pressure (SBP) compared to a waiting-
list control condition, but group BP differences 4 months
later were not significant [31]. In another study, relaxation
training combined with increased physical activity did not
decrease BP compared to a control group in community-
home boys [32].
Recent research suggests that behavioral stress reduc-
tion via Transcendental Meditation (TM) may hold prom-
ise in the reduction of casual BP and/or CVR in at-risk
youth. Recent clinical trials found that TM lowered clinic
BP, and reduced the risk of heart disease, carotid athero-
sclerosis, and mortality in hypertensive AA adults
[33–37]. Further, a recent finding with long-term TM
practitioners indicated that acute declines in BP during
TM are due to decreases in TPR [38]. Goleman and
Schwartz [39] found that TM reduced heart rate (HR)
reactivity to a stressful film in normotensive CA adults,
but another study of normotensive CA adults found no
decreases in HR or BP reactivity to three laboratory stres-
sors [40]. TM has also been shown to effect beneficial
stress-related physiological changes, including decreased
sympathetic nervous system arousal [41,42], hypothala-
mic–pituitary – adrenocortical axis dysregulation [43,44],
cortisol levels [44], and sympathetic b-adrenergic receptor
sensitivity [45]. These findings suggest that examination of
the effects of TM on reducing BP and CVR in at-risk youth
is warranted.
In the present study, youth with high normal BP, prim-
arily AAs, were randomly assigned to either a 2-month
TM program or a health education control (CTL) group.
Based on previous findings, it was predicted that youth
who practiced TM would exhibit greater decreases in
resting BP and TPR, and greater decreases in CVR to
laboratory stressors from pretest to 2-month posttest
than controls.
Method
Participants
Permission to conduct the study was granted by the
Superintendent of Richmond County Public Schools and
the Medical College of Georgia Human Assurance Com-
mittee. A BP screening was conducted on a random sample
of youth at an inner-city high school (200 students,
97% AAs). Thirty-five adolescents (34 AAs, 1 CA; ages
15–18 years) exhibited resting SBP in the sitting position in
the 85th and 95th percentile for their age and gender
on three consecutive occasions [46]. Exclusion criteria
included: current involvement in a health promotion pro-
gram; unwillingness to accept randomization into either
study group; self-reported pregnancy or parental report of
subject’s history of congenital heart defect, diabetes, asthma,
or any chronic illness that requires regular pharmacological
intervention. None were affected and all consented to
participate in the study.
Subjects were given the preintervention as described
below and randomly assigned to either a TM group
(n= 17; 7 AA and 1 CA female, 9 AA males) or a
CTL group (n= 18; 8 AA females, 10 AA males). The
TM group engaged in 15-min sessions each day at school
at 10:30 a.m. Additional 15-min individual sessions were
prescribed at home, each school day, as well as 15 min
twice daily individual home practice on weekends for
2 months. The CTL group was presented with seven
weekly one-hour lifestyle education sessions based in part
on the National Institutes of Health guidelines on low-
ering BP through weight loss, diet (reducing fat and
sodium intake), and increasing physical activity [47].
These sessions were intended to provide comparable time
and attention to the CTL subjects. Two subjects dropped
out of the TM group and did not complete the post-
intervention. Attendance was taken for all sessions at
school and weekly ‘‘participation cards’’ were completed
by the subjects to document meditations at home. Two
months after receiving the intervention, both groups were
posttested as described below. A 2-month intervention
period resulted due to constraint imposed by the school
semester period. Several studies using TM have reported
BP reductions at 1 – 3 months [34,48,49]. Subjects were
paid US$150 for their participation.
Intervention
The TM technique has been described as a simple mental
procedure practiced for 15 min twice a day while sitting
comfortably with eyes closed [50]. The TM technique has
its origin in the ancient Vedic approach to health [51], and
does not require changes in personal belief, lifestyle, or
philosophy [52]. No mental effort is required toward inten-
tionally altering physiological processes (e.g., respiration
rate, muscle relaxation, etc.). The ordinary thinking process
becomes quiescent and a distinctive state of psychophysio-
logical ‘‘restful alertness,’’ a wakeful but deeply restful
state, is gained [53,54].
Procedures
Measurements
All testing was conducted at the Georgia Prevention
Institute of the Medical College of Georgia. After a consent
form was signed, anthropometric and hemodynamic param-
eters were measured, at both the pre- and posttest. At
pretest, subjects completed an expectation-of-benefits ques-
tionnaire, and parents completed a demographic informa-
tion form [which includes measures of socioeconomic
status, and a family health history of cardiovascular (CV)
disease form].
V.A. Barnes et al. / Journal of Psychosomatic Research 51 (2001) 597–605598
Anthropometrics
Height (via stadiometer), weight (via Detecto scale),
waist and hip circumference measurements were recorded
using established protocols [55,56].
Hemodynamics
Outcome measures were changes in BP, HR, cardiac
output (CO), and TPR at rest and in response to a virtual
reality car driving simulation task and social stressor inter-
view. All CV measurements were conducted with the subject
in the supine position. BP was monitored with a Dinamap
Vital Signs Monitor 1846SX [57]. CO and HR measurements
were obtained using a noninvasive thoracic electrical bio-
impedance system (NCCOM-3 Model 6, Bo-Med Medical
Manufacturing, Irvine, CA). The bioimpedance-measuring
procedure has been validated via significant correlations
between the NCCOM-3 readings and simultaneous thermo-
dilution-derived estimates of CO [58,59]. CO and HR were
calculated every successive 12 QRS complexes with the
bioimpedance monitor while the Dinamap was inflating and
calculating BP. These values were averaged to provide one
measurement for each BP evaluation. BP and CO values
measured simultaneously were used to calculate TPR as
{TPR=(SBP + 2DBP)/3/CO} expressed as mmHg/(l/min)
where DBP stands for diastolic blood pressure.
A calibration protocol was used, which adjusted imped-
ance-derived values of stroke volume (SV), and thus CO to
Doppler-derived measures [16]. During each visit, each sub-
ject’s bioimpedance system-derived SV measures at rest were
calibrated based upon M-mode echocardiography-derived SV
measurements, which have been shown to provide absolute
measurements of SV and CO [60,61]. An M-mode echocar-
diographic examination using a Hewlett-Packard 5500 echo-
cardiograph was conducted to measure aortic flow velocity.
Utilizing computer analysis and the area under the velocity
curve (flow velocity integral), SV and CO were calculated.
The average Doppler-derived SV values during rest for each
subject in conjunction with their HR values were compared to
the subject’s average impedance-derived resting SVs at the
same HRs. The percentage differences in SV were used as a
(b) Preintervention cardiovascular responsivity to stressors by intervention
TM CTL
Prestressor level Mean stressor level Prestressor level Mean stressor level
Car driving
SBP (mmHg) 125.9 ± 8.2 139.5 ± 8.3 119.3 ± 7.8 127.2 ± 13.2
DBP (mmHg) 61.7 ± 7.8 75.2 ± 10.2 63.5 ± 8.1 70.0 ± 8.3
HR (bpm) 64.6 ± 9.6 79.1 ± 9.7 65.7 ± 7.3 72.8 ± 11.2
CO (l/min) 4.9 ± 1.3 5.4 ± 1.3 5.2 ± 1.4 5.2 ± 1.5
TPR (mmHg/(l/min)) 17.9 ± 4.7 19.1 ± 5.1 17.4 ± 7.2 18.7 ± 6.1
Social stressor interview
SBP (mmHg) 123.7 ± 8.5 140.0 ± 10.2 118.1 ± 6.1 133.8 ± 7.2
DBP (mmHg) 62.0 ± 8.1 73.0 ± 9.9 62.6 ± 8.3 72.9 ± 9.4
HR (bpm) 66.0 ± 9.3 73.0 ± 10.4 66.4 ± 13.6 70.9 ± 9.5
CO (l/min) 5.0 ± 1.3 4.9 ± 1.3 5.1 ± 1.4 5.1 ± 1.3
TPR (mmHg/(l/min)) 17.3 ± 4.4 20.8 ± 5.7 17.2 ± 6.6 20.0 ± 6.8
Values are means ± standard deviation. SBP = systolic blood pressure; DBP= diastolic blood pressure; HR= heart rate; CO = cardiac output; TPR = total
peripheral resistance. All TM vs. CTL effects = not significant.
Table 1
Preintervention descriptive characteristics and cardiovascular responsivity to stressors by intervention
(a) Preintervention descriptive characteristics by intervention
TM (n= 15) CTL ( n= 18)
Anthropometric/demographic
Age (years) 16.5 ± 1.1 16.6 ± 1.1
Weight (kg) 87.1 ± 21.8 91.2 ± 25.7
Height (cm) 170.6 ± 6.8 171.0 ± 8.2
Body surface area (m
2
) 1.98 ± 0.25 2.02 ± 0.27
Body mass index (kg/m
2
) 29.7 ± 6.2 31.2 ± 8.6
Ponderal index (kg/m
3
) 17.4 ± 3.4 18.3 ± 5.2
Waist-to-hip ratio 0.81 ± 0.07 0.81 ± 0.09
Baseline resting CV function
SBP (mmHg) 124.7 ± 9.1 118.8 ± 8.2
DBP (mmHg) 61.6 ± 7.1 59.7 ± 5.8
HR (bpm) 65.3 ± 9.5 66.0 ± 12.8
CO (l/min) 4.9 ± 1.2 5.1 ± 1.3
TPR (mmHg/(l/min)) 17.7 ± 4.5 16.4 ± 5.3
V.A. Barnes et al. / Journal of Psychosomatic Research 51 (2001) 597–605 599
calibration for impedance-derived SV measures during the
formal evaluation. This approach resulted in standardization
of all CO and TPR readings providing a more accurate means
of measuring absolute responses to the stressors.
Following instrumentation with the CV monitoring
equipment, all subjects were placed in a supine position
and instructed to relax as completely as possible by closing
the eyes, freeing the mind of distracting thoughts, and
concentrating on breathing in a slow regular manner for
15 min. CV responses were simultaneously measured during
minutes 10, 12, and 14. Following baseline evaluation,
during both the preintervention and 2-month postinterven-
tion evaluations, the virtual reality car driving simulation and
social stressor interview were presented, with the order of
presentation counterbalanced among subjects but maintained
within-subject for both evaluations. The car driving simu-
lation stressor was chosen as an individual behavioral
challenge and the social stressor interview was chosen as
an interpersonal relationship challenge. Both stressors have
been shown to increase sympathetic arousal and CVR to
each has been predictive of CV risk factors in youth such as
increased BP levels and left ventricular mass [20,62]. Full
details of the stressor protocols have been presented in earlier
reports [63,64]. The car driving stressor and social stressor
interview were presented in the supine position. During each
10-min behavioral stressor, and each 15-min recovery
period, CV readings were obtained every other minute.
Car driving simulation stressor
The virtual reality car driving protocol was developed in
our lab [64]. The subject was fitted with a Kaiser-Optic
Virtual Immersion monitor (VIM-500, Kaiser Aerospace
and Electronics, Carlsbad, CA) fitted on his/her head. The
VIM 500 was interfaced with a Panasonic Real 3DO
(b) Postintervention cardiovascular responsivity to stressors by intervention and time
TM CTL
Prestressor level Mean stressor level Prestressor level Mean stressor level Significant effects
Car driving
SBP (mmHg) 121.1 ± 9.5 130.2 ± 10.9 119.8 ± 12.3 131.2 ± 13.9
abc
*
DBP (mmHg) 59.1 ± 10.0 69.5 ± 11.2 60.7 ± 7.6 71.8 ± 10.1
HR (bpm) 66.2± 11.1 76.9 ± 12.7 64.8 ± 8.9 75.3 ± 14.9
abc
*
CO (l/min) 4.8 ± 1.4 4.9 ± 1.5 5.4 ± 1.3 5.7 ± 1.3
abc
*
TPR (mmHg/(l/min)) 17.8 ± 5.2 20.1 ± 6.0 15.4 ± 3.5 19.1 ± 9.4
Social stressor interview
SBP (mmHg) 126.0 ± 10.8 133.1 ± 10.9 121.0 ± 10.9 133.1 ± 12.2
abc
*
DBP (mmHg) 64.5 ± 7.1 70.2 ± 9.5 61.5 ± 6.3 69.7 ± 6.8
bc
*
HR (bpm) 70.0± 10.5 74.7 ± 9.7 66.0 ± 9.9 71.7 ± 12.4
CO (l/min) 4.7 ± 1.6 4.6 ± 1.4 5.3 ± 1.4 5.7 ± 1.6
ab
*
TPR (mmHg/(l/min)) 21.3 ± 11.4 22.9 ± 11.8 16.3 ± 4.8 17.2 ± 5.0
ab
**
,bc
Values are means ± standard deviation.
a
Intervention effect (TM vs. CTL).
b
Time effect (pre- vs. postintervention).
c
Phase effect (prestressor vs. task level).
*P< .05
** P< .10
Table 2
Postintervention descriptive characteristics and cardiovascular responsivity to stressors by intervention and time
(a) Postintervention descriptive characteristics by intervention
TM (n= 15) CTL ( n=18) Significant effect
Anthropometric/demographic
Age (years) 16.7 ± 1.1 16.8 ± 1.1
Weight (kg) 88.1 ± 20.8 92.0 ± 26.1
Height (cm) 170.5 ± 6.7 171.0 ± 8.2
Body surface area (m
2
) 1.99 ± 0.24 2.03 ± 0.27
Body mass index (kg/m
2
) 30.1 ± 6.1 31.4 ± 8.8
Ponderal index (kg/m
3
) 17.6 ± 3.4 18.4 ± 5.3
Waist-to-hip ratio 0.83 ± 0.08 0.83 ± 0.08
Baseline rest CV function
SBP (mmHg) 119.9 ± 9.1 121.4± 11.2
ab
*
DBP (mmHg) 58.1 ± 8.5 60.9 ± 7.9
ab
*
HR (bpm) 66.2 ± 11.2 64.5 ± 8.5 ns
CO (l/min) 5.0 ± 1.3 5.3 ± 1.3 ns
TPR (mmHg/(l/min)) 16.4 ± 5.3 16.3 ± 4.6 ns
V.A. Barnes et al. / Journal of Psychosomatic Research 51 (2001) 597–605600
Interactive Multiplayer System (Model FZ-1, Matsushita
Electric of America, Secaucus, NJ) for the CD ROM ‘‘Need
for Speed’’ (Pioneer Productions and Electronic Arts, Bur-
naby, Canada). The Panasonic 3DO system incorporates a
handheld control pad. Standardized instructions and a
demonstration were given by a trained research assistant.
The subject engaged in the stressor under a condition of
challenge was prompted every minute to drive as fast as
possible. The research assistant recorded the average and
peak driving speed. Subjects then completed nine Likert
scale questions which assessed perception of task involve-
ment, skill level, and experience with the game, and
affective state changes during the stressor.
Social stressor interview
The social stressor interview was previously validated for
use with adolescents [63]. During the interview, the subject
discussed a recent socially stressful event. The interviewer
presented the subject with a list of problems concerning
school, family, friends, work, and money, which recently
resulted in anger and/or frustration. Through guided
imagery and reflective listening, the interviewer attempted
to promote accurate reexperiencing of the event, including
the subject’s affective and behavioral responses. This was
followed by a summary of the outcome of the event and the
subject’s perception of satisfaction with his/her responses to
the event. Subjects then completed six Likert scale questions
which assessed perception of task involvement and affective
state changes during the stressor.
Statistical analyses
To ensure comparability between the two groups at pre-
and postintervention on all sociodemographic (e.g., socio-
economic status, family history of CVD) and anthropomet-
ric variables (e.g., skinfolds, weight, height), a series of 2
(Intervention: TM vs. CTL) 2 (Time: pre- vs. postinter-
vention) repeated-measures analyses of variance (ANOVA)
with time as the repeated measure was conducted.
Supine resting CV data (i.e., SBP, DBP, HR, CO, TPR)
were analyzed as dependent variables using 2 (Intervention:
TM vs. CTL) 2 (Time: pre- vs. postintervention) repeated-
measures ANOVAs with time as the repeated measure.
Multivariate repeated-measures analyses of covariance
(MANCOVAs) were conducted separately for each stressor
using the mean CV responses (i.e., SBP, DBP, HR, CO, TPR)
as the dependent variables with phase (prestressor vs. stress
response) and time (pre- vs. postintervention) as repeated-
measures factors, intervention (TM vs. CTL) as the grouping
factor, and supine resting CV values as covariates. Follow-up
comparisons were not needed because there were only two
levels for each of the independent variables.
Results
Descriptive characteristics
The average attendance of the TM and CTL groups at the
school sessions was 67.8% and 68.2%, respectively. The
average self-reported compliance with TM practice at home
was 76.6%. The percentage of students attending at least 60%
of the total possible sessions was 80% for the TM groups and
58% for the CTL group. Descriptive characteristics of the TM
and CTL groups are presented in Tables 1a and 2a. There
were no significant main (i.e., intervention, time) or inter-
action effects for any parameter (all Ps > .36) indicating that
the groups did not differ significantly at preintervention in
expectation of benefits nor at pre- or postintervention in any
anthropometric or demographic parameters.
Resting CV evaluations
The unadjusted means and standard deviations for the
resting CV parameters as a function of intervention status
Fig. 1. Change in supine resting SBP (pre- minus postintervention) after a
2-month intervention.
Fig. 2. Change in SBP reactivity (mean stressor minus prestressor level) to
the car driving simulation stressor (pre- minus postintervention) comparing
TM vs. CTL groups after a 2-month intervention.
V.A. Barnes et al. / Journal of Psychosomatic Research 51 (2001) 597–605 601
and time are presented in Tables 1b and 2b. Analyses
revealed no main effects for intervention on any CV
parameter ( Ps >.42). A Group Time interaction (Fig. 1,
P< .03) for SBP indicated that at postintervention, the TM
group exhibited lower while the CTL group exhibited
slightly higher resting SBP than at preintervention. An
Intervention Time interaction indicated a trend such that
the TM group exhibited lower while the CTL group exhib-
ited higher resting DBP at postintervention ( P< .06).
CV responsivity evaluations
Car driving simulation stressor
For the MANCOVA analyses, the most important term to
be tested was the three-way interaction of Intervention
Phase Time. The MANCOVAs revealed significant phase
effects for all CV parameters ( Ps < .04), indicating that
subjects exhibited significant CV arousal to the stressors.
For the car driving stressor, Intervention Phase Time
interactions were observed for SBP (Fig. 2, P< .03), CO
(P< .01), and HR ( P< .03) and for a trend was noted for DBP
(P< .07). The nature of these interactions was such that
differences between the prestressor and stress responses
(reactivity) were smaller at postintervention for the TM
compared to the CTL group which showed a slight increase.
There were no significant differences between the groups
in self-reported task involvement, and affective responses to
the stressors at pre- or postintervention ( Ps >.14). At pre-
intervention, there were no significant differences between
the groups on maximum (TM: 113.8 ± 14.1; CTL: 114.6 ±
7.9 mph) and average (TM: 70.8 ± 6.0; CTL: 66.5 ± 11.3 mph)
driving speeds ( Ps >.24) during the car driving stressor. At
postintervention during the car driving simulation task, the
TM group exhibited higher maximum (TM: 119.3 ± 10.1;
CTL: 114.8 ± 8.7 mph, P< .04), but similar average (TM:
74.4 ± 7.8; CTL: 72.9 ± 13.3 mph) driving speeds.
Social stressor interview
A less consistent pattern of findings was noted for the
social stressor interview. The MANCOVAs revealed sig-
nificant phase effects for all CV parameters ( Ps < 0.04),
except for CO ( P>.10), indicating that subjects exhibited
significant CV arousal to the stressors. For SBP, there was
a significant Group Phase Time interaction (Fig. 3,
P< .03). The interaction was such that the differences
between the prestressor and stress response were mark-
edly smaller at post- compared with preintervention
for the TM compared to the CTL group for which
the differences were slightly smaller at post- compared
with preintervention.
Discussion
This study examined the impact of a 2-month participa-
tion in the TM technique on CV function at rest and during
acute stress in adolescents with high normal BP. With
respect to resting CV function, the TM group exhibited
greater decreases in resting SBP and a trend for greater
decreases in DBP compared to the control group. These
findings were not attributable to differences in anthropo-
metrics or demographics since the TM and control groups
were similar on these parameters at pre- and postinterven-
tion, and both groups were similar in their expectations of
health benefits at preintervention. Eisenberg et al. [65] were
unable to document the efficacy of various types of stress
reduction approaches upon EH (e.g., biofeedback, relaxa-
tion, stress management, and/or non-TM meditation) under
controlled conditions. However, the present findings are
consistent with adult studies which have shown that TM
reduced BP significantly in older hypertensive AAs [34] at
3 months, CAs [49] at 3 months, normotensive Asian
medical students at 1.5 and 3 months [48], and in normo-
tensive CA college students over 4 months [40].
Few BP-related stress reduction studies have been con-
ducted in youth and findings have been mixed. Relaxation
training combined with increased physical activity for
4 months failed to yield any BP differences in commun-
ity-home boys compared to a control group [32]. A daily
PMR program conducted for 4 months at school in teen-
agers with high normal BP showed a 5.3 mmHg greater
decrease in their SBP compared to a waiting-list control
condition [31]. The present findings compare favorably with
the results of that study [31] in that the TM group exhibited
a 4.8-mmHg greater decrease in SBP compared to a
2.6-mmHg increase in the CTL group.
Only a few studies have examined the impact of TM
upon CVR and all have involved adults. TM was shown
to decrease HR reactivity to viewing a stressful film in
normotensive adults [39]. No significant changes were
Fig. 3. Change in SBP reactivity (mean stressor minus prestressor level) to
the social stressor interview (pre- minus postintervention) comparing TM
vs. CTL groups after a 2-month intervention.
V.A. Barnes et al. / Journal of Psychosomatic Research 51 (2001) 597–605602
reported in either BP or HR reactivity to mental arith-
metic, mirror star tracing, public speaking, or an isometric
handgrip task in a 4-month study comparing TM to a
stress education control group in normotensive CA college
students [40]. The present findings in youth extend these
reports. Greater decreases in SBP, HR, and CO reactivity
and a trend for a greater decrease in DBP reactivity were
observed in the TM group compared to increases in the
control group during the car driving simulation task. With
respect to the social stressor interview, both groups
exhibited decreases in SBP reactivity but a greater
decrease was observed in the TM group compared to
the control group.
Why TM had a more consistent impact on CVR to car
driving simulation is unknown. Perhaps TM subjects exhib-
ited decreased sympathetic arousal to the car driving simu-
lation on the postevaluation due in part to improved
perceptual– motor coordination and/or faster reaction time
previously observed to be a result of TM [66,67]. Partial
support for this hypothesis is provided by the higher peak
driving speed for the TM group on the second visit. No
other measures of driving-related performance (e.g., number
of wrecks, time off of road, etc.) were recorded. Future
stress reduction studies evaluating possible CVR reduction
to perceptual– motor or cognitive skills stressors may bene-
fit from inclusion of relevant performance measures. Rea-
sons for the increased CVR to car driving simulation in the
CTL group are also unknown. Although many studies have
reported a decrease in CVR to the same stressor over time,
findings have been mixed and a number have reported
increases in CVR. For example Mills et al. [68] reported
increases in SBP (6 mmHg), DBP (4 mmHg), and HR
(3 bpm) reactivity to standing and math stressors given
10 days apart.
Although intriguing and supported by the adult literature,
the present findings should be interpreted cautiously since
impact of health education on change in lifestyle-related
moderators, such as diet (e.g. sodium intake), physical
activity, and environmental stress were not evaluated. How-
ever, all subjects resided in the same geographical locale
(i.e., lower socioeconomic status neighborhoods), and none
participated in any formal sports or lifestyle programs
during the intervention period, besides physical education.
Further, there were no significant differences between the
groups in changes in weight or adiposity, which would
provide some indication of significant diet and/or physical
activity lifestyle changes. The study did not provide the
groups with knowledge regarding the impact of stress on BP
and other CV variables. Although efforts were made to
provide comparable instruction time and attention at school
to both groups, the TM group did receive greater direct
contact. While TM is not conventionally practiced during
lunch breaks, this facilitated fitting a daily session into the
school schedule without taking time from the academic
schedule. In other studies, neither lifestyle modification
education matched for direct attention, nor waiting-list
control groups showed significant decreases in resting BP
[31,32,34]. Further, one of these studies found the CTL
group to exhibit slight increases in clinic BP at follow-up
compared to the decrease exhibited by the TM group [34].
To our knowledge, no studies have shown whether
relaxation-reduced CVR in youth prevents the development
of EH. The health-damaging effects of CVR are thought to
be due to the accumulation of repeated occurrences that
eventually produce detrimental alterations in CV structure
and function [69]. Since it is frequently many years before
children display overt clinical symptoms of CV disease,
longitudinal studies are needed to examine the impact of
reduced CVR or the development of preclinical manifesta-
tion of increased EH risk (e.g., left ventricular hypertrophy,
endothelial dysfunction, increased resting BP). Future stud-
ies would benefit from inclusion of follow-up evaluation to
determine whether impact of TM is lasting. Also, evaluation
of possible moderators such as diet, physical activity, and
social support would be beneficial.
To our knowledge, this is the first controlled randomized
study of reduction of resting BP and CVR to acute stress in
at-risk youth using behavioral stress reduction via TM. The
successful implementation of the intervention points to the
potential of school-based stress reduction programs to
prevent early onset of EH in high-risk youth, particularly
AAs. The results of this study contribute to the currently
limited knowledge of the efficacy of stress reduction pro-
grams in reducing resting BP and CVR to acute stress.
Acknowledgments
We would like to thank Dr. Charles Larke, Super-
intendent; Dr. Rush Utley and Mr. Quentin Motley,
Principals, Richmond County Public Schools in Augusta,
GA for their cooperation in providing the facilities for this
study. This study was supported in part by National
Institutes of Health Grant #HL62976 to Dr. Treiber and an
American Heart Association Scientist Development Grant
#9930073N to Dr. Barnes.
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