Progressive Muscle Relaxation and Guided Imagery

Progressive Muscle Relaxation and Guided Imagery

PEP Topic 
Fatigue
Description 

Progressive muscle relaxation (PMR) is a technique of alternately tensing and relaxing muscles groups in sequence throughout the body. When going through muscle groups, individuals can start with the head and neck and progress to the feet, or vice versa. Similarly, individuals may do one side of the body at a time, or both sides simultaneously.  Listening to a prerecorded script may be used to guide individuals through the process.  Addition of guided imagery to PMR involves use of mental visualization and use of imagination to enhance relaxation and alter specific experiences and may or may not include direct suggestion. Individuals may use recorded scripts to guide the creation of mental images. Guided imagery can integrate techniques founded in multiple psychological theory and hypnotherapy.  PMR with guided imagery has been examined for effectiveness in patients with cancer for chemotherapy-induced nausea and vomiting, anxiety, fatigue, sleep-wake disturbance, and pain.
 

Effectiveness Not Established

Research Evidence Summaries

Decker, T. W., Cline-Elsen, J., & Gallagher, M. (1992). Relaxation therapy as an adjunct in radiation oncology. Journal of Clinical Psychology, 48, 388–393.

doi:10.1002/1097-4679(199205)48:3<388::AID-JCLP2270480318>3.0.CO;2-O
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Intervention Characteristics/Basic Study Process:

Patients were instructed in six individual one-hour sessions on the use of progressive muscle relaxation (PMR) and were provided with a relaxation tape and written instructions. In addition to relaxation training, the session provided support focused on concerns related to cancer radiation treatment and its effects and on the physical and emotional sensations experienced. During the fourth session, cue-controlled relaxation was presented as an active coping process that included four steps:  PMR, deep breathing, pairing the relaxed state with a self-induced cue word (“calm"), and coping with tension by self-administration of the cue-controlled relaxation response. During the last session, client concerns about cancer, treatments, stress, and relaxation were reviewed, and further questions were answered. The importance of practicing relaxation regularly at home was emphasized. The control group received usual care.

Sample Characteristics:

  • Fifty-two women and 30 men scheduled to receive external beam radiation therapy were assigned randomly to the relaxation therapy condition or a control condition.
  • Mean age was 61 years (range 37–84).
  • The primary disease sites represented were breast (36%), prostate (17.5%), and colon (10%).
  • Of the patients, 92% were being treated with curative intent.

Setting:

Outpatient radiation treatment facility

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

The study was a randomized, controlled trial with a usual care control group.

Measurement Instruments/Methods:

Profile of Mood States (POMS)

Results:

Patients receiving relaxation training reported a significant reduction in tension and anger and a trend toward less depression. Comparisons between the relaxation therapy and control groups using MANOVA indicated that there were no statistically significant differences in the pre- and posttest scores for the controls, with the exception of fatigue; patients in the control group became significantly more fatigued (p = 0.01).

Limitations:

  • Patient adherence to relaxation exercises at home was unknown.
  • Outcome assessors were not blinded to treatment assignment.
  • The study had a small sample size, and no power analysis was provided.
  • The study design did not include an attention-placebo condition to control for the effects of suggestion and attention.
  • The relative importance of the different components of the intervention cannot be known.
  • Professional training is required to deliver the supportive care and psychoeducational component of the intervention.

Demiralp, M., Oflaz, F., & Komurcu, S. (2010). Effects of relaxation training on sleep quality and fatigue in patients with breast cancer undergoing adjuvant chemotherapy. Journal of Clinical Nursing, 19, 1073–1083.

doi: 10.1111/j.1365-2702.2009.03037.x
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Study Purpose:

To investigate the effect of progressive muscle relaxation (PMR) training on sleep quality and fatigue in Turkish women with breast cancer undergoing adjuvant chemotherapy.

Intervention Characteristics/Basic Study Process:

Following the eligibility assessment and obtaining informed consent, patients in the PMR group were invited to a private practice room for relaxation training. Patients in the PMR group were given PMR therapy in addition to chemotherapy and routine nursing services at the outpatient unit. Patients in the control group had chemotherapy and routine nursing services without PMR therapy. PMR therapy was performed in 25- to 30-minute sessions on the first and fifteenth days of each chemotherapy cycle. Patients in the intervention group were given a CD and encouraged to do exercises every day at home.

Sample Characteristics:

  • The sample was comprised of 27 women (PMR group, n = 14; control group, n = 13).  
  • Age ranged from 25 to 65 years.
  • To participate, patients had to be recently diagnosed with breast cancer, be undergoing adjuvant chemotherapy for the first time, and have no metastases or recent psychological treatments. 
  • All patients were living in the city where the research was performed and were literate in Turkish.

Setting:

The study was conducted in the outpatient unit of the medical oncology department of the Gulhane Military Medical Academy in Turkey.  

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment (chemotherapy) phase of care.

Study Design:

The study used a prospective, repeated-measures, quasiexperimental design with a control group.

Measurement Instruments/Methods:

  • Sociodemographic and clinical characteristics
  • Pittsburgh Sleep Quality Index (PSQI)
  • Piper Fatigue Scale (PFS)

Results:

The PMR group experienced a greater increase in improved sleep quality and a greater decrease in fatigue than the control group. Mean sleep efficiency, sleep distrubances, and total PSQI scores were significantly lower in the control group (p < 0.05). Total fatigue scores were significantly better in the experimental group compared to the control group (p = 0.014).

Conclusions:

The findings suggested that PMR training may improve sleep quality and fatigue in patients with breast cancer undergoing adjuvant chemotherapy.

Limitations:

  • The study had a small sample size.
  • The article included no discussion or measurement of adherence to home PMR; therefore, the intervention dose is unknown.
  • There was no discussion of therapist experience or education.
  • Information was lacking about therapist training or strategies to maintain intervention fidelity.
  • The study had no random assignment or attentional control.

Nursing Implications:

PMR training given by a nurse may improve sleep quality and fatigue in patients with breast cancer. It is important to start relaxation training just before chemotherapy to decrease the frequency and severity of sleep problems and symptoms, such as fatigue during chemotherapy.


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