EFFECTS OF AEROBIC EXERCISE ON LIPID PROFILE IN

MIDDLE AGED POST MENOPAUSAL WOMEN

CHAPTER 1
 INTRODUCTION

1.1 Background:
Menopause is defined as permanent termination of the primary functions of the ovaries,
release of ova and hormones that causes uterine lining and shedding 1. The average age of
menopause is 51 yr2. Menopause may increase risks of cardiovascular disease, osteoporosis,
abnormal lipid profile, and overweight3,4. There is always a sharp increase of hypertension
and metabolic dysfunctions after menopause.5
In women’s life, Post menopause is the stage which is staying top on the wellness to remain
healthy and manage the risk factors. It is important to know about the risk factors and engage
in ways to reduce the risk. Menopause will not cause any cardiovascular diseases, but it may
increase the risk of causing it. Menopause leads to changes in lipid profile by reducing HDL,
and elevating Total Cholesterol (TC), triglycerides (TG), LDL-cholesterol and VLDL-
cholesterol, thus increasing the risk for cardiovascular disease. These changes are caused by
reduced estrogen concentrations which are seen in menopause6.
The shift in hormones as well as changes to blood pressure, “bad” cholesterol, and
triglycerides can also occur following menopause. Abnormally elevated blood pressure and
lipid profile is associated with future risk of cardiovascular disease. According to
the American Heart Association, one in three women develops cardiovascular disease.
There’s an increase in incidence of heart attacks for women 10 years after menopause7,8.
Physical activity is an effective alternative to estrogen supplementation. Furthermore, aerobic
exercise can significantly change estrogen metabolism, such as increase the ratio of the
estradiol metabolites 2-hydroxyestrone and 16 α hydroxyestrone (2-OHE1/16_-OHE1) in
premenopausal women, which may lower breast cancer risk. Regular physical activity is
highly effective in improving aerobic fitness and physiological adaptations for cardiovascular
health and reaches a 30–40% reduction in the risk of heart disease in all populations. It is well
recognized that regular exercise training has been shown to be a therapeutic approach in
managing cardiovascular diseases because it provides the most comprehensive benefits for
reducing cardiovascular risk factors9.
Aerobic or resistance exercise is known to effectively reduce blood pressure, which is
associated with the improved cardiovascular autonomic mechanisms in hypertensive
postmenopausal state. Beneficial effects of aerobic exercise can be extended to
ovariectomized hypertensive rats, as evidenced by arterial pressure reduction associated with
enhanced cardiac vagal tonus and baroreflex sensitivity10.
Aerobic exercise should be emphasized, with some resistance exercise included, although we
observed aerobic exercise training seemed to have greater improvement on blood pressure
and enhancement of no exercises than combined aerobic and resistance exercise training in
postmenopausal hypertensive women. However, increased muscle strength is inversely
related with the risk of hypertension and frailty in older women 13,14. A beneficial aspect of
combined exercise may be reduced arterial stiffness and blood pressure in postmenopausal
women with hypertension, indicating that combined exercise modality may be clinically
beneficial for reducing the risk of frailty and mortality in hypertensive postmenopausal
women15.
Aerobic exercises, aquatic exercises and relaxation are the methods used to control
hypertension in hypertensive postmenopausal women. Aerobic exercise provides
cardiovascular conditioning14. The term aerobic actually means "with oxygen," which means
that breathing controls the amount of oxygen that can make it to the muscles to help them
burn fuel and move. In general aerobic exercise Improves cardiovascular conditioning,
decreases risk of heart disease, lowers blood pressure, increases HDL or "good" cholesterol,
helps to better control blood sugar, assists in weight management and/or weight loss,
improves lung function, decreases resting heart rate15-17.

1.2 Aim of this study:

To evaluate the effectiveness of aerobic exercise on abnormal lipid profile in a middle

aged postmenopausal women and to make their life healthy using exercises.

1.3 Objective of this study:

 To find the effectiveness of aerobic exercises in Rate Pressure Product (RPP),

Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) in middle aged post
menopausal women.
 To find the effectiveness of aerobic exercises in Lipid Profile parameters of HDL,
LDL, Triglycerides and Total Cholesterol in middle aged post menopausal women.
  To analyse and interpret the effectiveness of aerobic exercises in Rate Pressure
Product (RPP), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP),
HDL, LDL, Triglycerides and Total Cholesterol in middle aged post menopausal
women.

1.4 Purpose of this study:

The purpose of this study to fulfill the requirement of academic completion in post graduate
program by doing this study on effectiveness of aerobic exercise program on blood pressure
and lipid profile in middle aged menopausal women.

1.5 Significance of this study:

By doing this study and based on results and interpretation of this study, the significant
importance of aerobic exercise program to improve the health status overall and
cardiorespiratory fitness level by reducing the risk factors like hypertension, dyslipedemia in
post menopausal women can be advocated to the community.

1.6 Operational Definitions:

Post Menopausal Women:

Women will no longer have periods or they are in menopause and having the symptoms of
post menopause like hypertension, dyslipedemia because of reduced production of oestrogen
hormone.

Aerobic Exercise:

Aerobic exercise is a form of physical activity in which body’s larger muscle groups will be
working in a rhythmic and repetitive manner by utilizing more oxygen for the energy
production. Aerobic exercises may increase the heart rate and how much oxygen your body
uses. Examples of aerobic exercises include walking, running, aerobic dancing, treadmill
walking, cycling and swimming.

Lipid Profile Test:

Lipid profile test is a basic blood investigation which is used to measure the levels of fats or
lipids in blood. It primarily measures High-density lipoprotein (HDL), Low density
lipoproteins (LDL), Triglycerides and Total cholesterol.
1.7 Hypothesis

1.7.1 Null Hypothesis:

H0 - There shall be no statistically significant changes on aerobic exercises given to the

patients with post menopausal hypertension and abnormal lipid profile.

1.7.2 Alternate Hypothesis:

H1 - There shall be statistically significant increase in HDL with changes in LDL on aerobic
exercises given to post menopausal women

H2 - There shall be statistically significant decrease in LDL with changes in HDL on aerobic
exercises given to post menopausal women
CHAPTER 2
 REVIEW OF LITERATURE
2.1 Exercise training in postmenopausal women

 Yi Yuan Lin., etal (2018) explained about the beneficial outcomes of exercise
training for hypertensive postmenopausal women include improvements in blood
pressure, autonomic tone, baroreflex sensitivity, oxidative stress, nitric oxide (NO),
bioavailability, and lipid profiles, as well as cardiovascular function and
cardiorespiratory fitness. They partly explain the fact that exercise training programs
have a positive effect for cardiovascular disease in hypertensive postmenopausal
women. This review suggests that various forms of endurance and resistance exercise
may have a beneficial effect on hypertensive postmenopausal women. Overall, the
studies reviewed herein support the therapeutic concept to promote physical activity
and to achieve physical fitness, and the essential conclusion is that moderate aerobic
exercise may be superior for eliciting cardiovascular benefits in hypertensive
postmenopausal women and resistance exercise may offer desirable benefits7.

 Beom Jun Ku., etal (2021) aimed to investigate the effect of a 12-week Taekwondo
self-defense training course on oxidative stress and inflammation in postmenopausal
women as a comparative study with randomized control trial. Sixteen middle-aged
women participated and were randomized into two groups: a control group (CG, n =
8) and a Taekwondo self-defense training group (TSDG, n = 8). The TSDG was
trained for 60 min, four times per week, for 12 weeks. The results of this study
suggest that Taekwondo self-defense training is an effective exercise that improves
agility, oxidative stress, and inflammatory responses in postmenopausal women18.

 Andrés F. Loaiza-Betancur., etal (2021)The effect of exercise training on blood

pressure in menopause and postmenopausal women were conducted as a systemic
randomized controlled trial using 40 women the objective of this systematic review
was to synthesize the effect of exercise training on SBP, DBP and mean arterial
pressure (MAP) in menopausal and postmenopausal women. And concluded as
exercise training reduces Systolic blood pressure, Diastolic blood pressure and Mean
 arterial pressure values in a statistically significant and clinically relevant way in
menopausal and postmenopausal women. They suggest that this training modality
should be the main prescribed in clinical practice as complementary therapy aimed to
prevent, control or treat hypertension in this population19.

2.2 Aerobic exercise and lipid profile

 Lamiaa Elsayyad., etal (2020) published in a biomedical research journal "Effect of

short-term aerobic exercise on lipid profile". of individuals who were engaged in
regular exercise for 8 weeks. The lipid profiles of 50 apparently healthy females
practiced regular aerobic exercise were analyzed using enzymatic and colorimetric
methods. There was a significant decrease (p<0.05) in serum level of Low Density
Lipoprotein-Cholesterol (LDL –C), in females practice regular aerobic exercise for 8
weeks, and there was a significant difference in serum level of Total Cholesterol
(TC), triglyceride (TG) and High-Density Lipoprotein (HDL) (p<0.05) when
comparing pre and post-exercises levels of lipid profiles, regular participants showed
a significant decrease in TC,TG, and LDL. TC, TG, LDL, VLDL, significantly
decrease while HDL–C significantly increases20.

 Tarek Ammar etal (2017) Effects of aerobic exercise on blood pressure and lipids in
overweight hypertensive postmenopausal women Forty five women aged from 49 to
60 years were randomly assigned into three groups. Group (A) 15 patients received
medicine, (B) 15 patients performed morning aerobic exercises and received
medicine, and group (C) 15 patients performed afternoon aerobic exercises and
received medicine .The results showed that there was a statistical significant
difference among all groups in systolic and diastolic blood pressure, favouring group
C. Also there was a statistical significant difference among all groups in lipid levels,
favouring group C. Therefore, it can be concluded that morning aerobic exercises
were more effective in reducing the blood pressure and lipids than afternoon exercises
in overweight hypertensive postmenopausal women17.

 Caminiti, G., etal. (2021) studied the effects of 12 weeks of aerobic versus combined
aerobic plus resistance exercise training on short-term blood pressure variability in
 patients with hypertension using a randomized trial and concluded that Combined
exercise training (CT) including aerobic plus resistance exercises could be more
effective in comparison with aerobic exercise (AT) alone in reducing blood pressure
variability (BPV) in hypertensive patients with P value 0.0121.

2.3 Lipid profile and post menopause

 Inaraja V., etal (2020), conducted an evidence based retrospective observational

study in a gynecology unit of Hospital Quirón Salud, Madrid (2007-2018) with
irregular menstruation, amenorrhea or menopausal symptoms. The studies evaluated
the lipid profile during the perimenopause to post menopause transition and its
association with menopausal status. The study samples were classified as
perimenopausal or postmenopausal based on the date of last menstruation .The study
suggested that there is some significant changes in LDL-c levels occur during the
menopausal transition. Total cholesterol and LDL-c changes are independently
affected by menopausal status and HDL-c is influenced by menopausal age22.

 Panagiotis Anagnostis., etal (2020) provided an evidence-based approach to

management of menopausal symptoms and dyslipedemia in postmenopausal women
using the retrospective clinical studies. The guide evaluates the effects on the lipid
profile both of menopausal hormone therapy and of non-estrogen-based treatments for
menopausal symptoms. With regard to menopausal hormone therapy, systemic
estrogens induce a dose-dependent reduction in TC, LDL-C and Lp(a), as well as an
increase in HDL-C concentrations; these effects are more prominent with oral
administration when compared to transdermal or micronized progesterone25.
CHAPTER 3
 METHODOLOGY

3.1 Study Design:

Pre and post experimental study design

3.2 Sampling Design:

Purposive and convenient sampling

3.3 Study population:

Post menopausal middle aged women

3.4 Study subjects:

30 middle aged women with post menopausal hypertension and abnormal lipid profile.

3.5 Study Duration:

6 Months

3.6 Treatment Duration:

30 minutes / day

3 days in a week for 6 - 8 weeks

3.7 Criteria of Selection:

Inclusion Criteria:

 Two years of Postmenopausal Women

 Age between 47-60 years
 Blood pressure range from 140/90 mmHg to <160/100 mmHg

Exclusion Criteria:

 Neurological dysfunction
 Osteo arthritis
 Inter vertebral disc prolapse
 Recent surgeries
 Surgical menopause
 Rheumatoid Arthritis
3.8 Outcome Measures:

Primary Outcome Measures:

Lipid Profile:

 High Density Lipid Protein

 Low Density Lipid Protein
 Triglycerides
 Total Cholesterol

The lipid profile tests included measurements of high density lipoproteins (HDL), low
density lipoproteins (LDL), triglycerides (TG) and total cholesterol (TC) before and after
the study in the blood testing laboratory. The blood analysis required 12-hours of fasting.
A sample of three milliliters of blood was obtained by inserting a needle into a vein in the
arm by a lab technician.

Secondary Outcome Measures:

 Rate Pressure Product (HR×SBP)

 Systolic Blood Pressure
 Diastolic Blood Pressure

Each participant was asked in sitting position, the cuff of the sphygmomanometer was
wrapped around the upper arm and a stethoscope was placed over the brachial artery. The
rubber cuff was inflated with the air. As the air in the cuff was released, the first sound
heard marked the systolic pressure. As the release of air from the cuff persisted, the point
where the sound disappeared marked the diastolic pressure. The tester took the average of
two blood pressure measurements.

3.9 Materials and Tools:

Blood Pressure Monitor (OMRON)
Blood Sample for Lipid Profile Test
3.10 Procedure:
After getting the ethical approval from concerned institute affiliated ethical and review
board, 30 postmenopausal women who met the inclusion criteria were recruited from out-
patient department of Santosh college of Physiotherapy. Written informed consent had
been taken from all the subjects. Demographic data of subjects includes age, BMI was
documented and recorded.

30 minutes of aerobic exercises included warm up, step aerobics, aerobic dancing,
jumping jacks, chair exercises like overhead stretch, seated cow stretch, seated cat stretch,
seated mountain pose, seated twist, and resistance band exercises. The frequency of
exercise was three times per week for six to eight weeks.

Measurement of heart rate and blood pressure was performed for each participant before
starting the study and after its end of every week using Sphygmomanometer.
Measurement of lipid profile test includes HDL, LDL, TG and Total Cholesterol was
taken by using blood sampling method.
CHAPTER 4
 DATA ANALYSIS AND RESULTS

Statistical Data Analysis:

 If the data is normally distributed, the parametric tests of paired t-test will be used for
within groups and Independent t-test will be used for between groups to test the
hypotheses.
 If the data is not normally distributed, the non-parametric tests of Wilcoxon Signed
Rank Test for within groups and Mann-Whitney U Test for between groups to test the
hypotheses.
IBM SPSS software version 25.0 was used for statistical data analysis.
Parametric Tests:
Paired t-test:
In statistics, a student’s t-test or t-test is the statistical method used to determine if there is a
difference between the means of two samples. The test is often performed to find out if there
is any sampling error or unlikeliness in the experiment. This t-test is further divided into three
types based on your data and result needs. The types are:
o One sample t-test: The mean of a single population is compared against the known
mean.
o Independent sample t-test: The mean of two different populations is compared.
o Paired sample t-test: The mean of the same group or population is at separate times.
A paired t-test (also known as a dependent or correlated t-test) is a statistical test that
compares the averages/means and standard deviations of two related groups to determine if
there is a significant difference between the two groups.
o A significant difference occurs when the differences between groups are unlikely to
be due to sampling error or chance.
o The groups can be related by being the same group of people, the same item, or being
subjected to the same conditions.

Formula:
The formula of the paired t-test is defined as the sum of the differences of each pair divided
by the square root of n times the sum of the differences squared minus the sum of the squared
differences, overall n−1. t=∑d√n(∑d2)−(∑d)2n−1. Here, ∑d is the sum of the differences.
Independent t-test:

The independent samples T-test is defined as statistical hypothesis testing technique in which
the samples from two independent groups are compared to determine if the means of the
associated populations are significantly different. The t-test compares the means of two
groups, such as a control group and a treatment group, to determine if the difference between
the groups’ means is statistically significant or due to random chance. For example, let’s say
that we have two independent groups of marketing professionals having similar qualification
and we want to compare their income to determine whether their income is significantly
different.

Independent samples t-test is also called unpaired two-samples t-test or just unpaired t-
test because the test is performed with only two groups that are independent or unpaired or
unrelated. The picture below shows the representation of two independent samples and the
aspect of their means.

Formula:

The t-statistics formula for independent samples t-test is different based on whether the
variances within the two different groups are same / equal or different (statistically).
When the variances of populations are not equal, the two samples t-test formula (equation)
for t-statistics is following:
Where X̄ 1 is mean of first sample, X̄ 2 is mean of second sample, μ1 is the mean of first
population, μ2 is the mean of second population, s1 is the standard deviation of first
sample, s2 is the standard deviation of second sample, n1 is the size of the first sample, n2 is
the size of the second sample.

Non Parametric Tests:

Wilcoxon Signed Rank Test (Equivalent to Parametric Paired t-test):

The Wilcoxon signed rank test, which is also known as the Wilcoxon signed rank sum test
and the Wilcoxon matched pairs test, is a non-parametric statistical test used to compare two
dependent samples (in other words, two groups consisting of data points that are matched or
paired). As with other non-parametric tests, this test assumes no specific distribution of the
data being analyzed (for example, whether or not it takes a Normal distribution). The
parametric equivalent to the Wilcoxon signed rank test is the dependent samples t-test
(or paired t-test).

Formula:

Mann Whitney U Test (Equivalent to Parametric Independent t-test):

The Mann-Whitney U test is thus the non-parametric counterpart to the t-test for independent
samples; it is subject to less stringent assumptions than the t-test. Therefore, the Mann-
Whitney U test is always used when the requirement of normal distribution for the t-test is
not met.

To compute a Mann-Whitney U test, only two independent samples with at least ordinal
scaled characteristics need to be available. The variables do not have to satisfy any
distribution curve.

Formula:
Master Chart

Table 1: Demographic Data

S.No Age BMI Post
Menopausal
Years
1 48 23.12 2
2 52 24.68 4
3 60 25.56 8
4 48 26.78 2
5 54 27.84 6
6 53 30.24 5
7 56 30.68 6
8 58 27.82 8
9 60 26.44 9
10 54 27.12 6
11 48 26.34 2
12 49 22.44 2
13 58 24.56 6
14 56 24.12 5
15 57 25.68 6
16 58 26.78 7
17 56 23.12 6
18 58 22.14 8
19 54 23.46 4
20 52 24.56 2
21 54 25.62 3
22 52 27.34 2
23 54 27.12 3
24 59 28.12 8
25 49 29.16 2
26 48 30.24 2
27 56 28.42 5
28 54 22.46 4
29 54 23.88 5
30 52 24.98 2
Table 2: Outcome Measures

S.No HDL LDL Triglycerides Total Rate Pressure

Cholesterol Product
(HR×SBP/100)
 Pre Post Pre Post Pre Post Pre Post Pre Post
1 25 38 102 90 220 190 190 170 108 91
2 28 35 98 84 198 164 150 145 110 94
3 30 38 104 88 250 215 200 155 112 98
4 28 38 104 90 254 220 210 154 108 92
5 30 36 96 90 184 173 164 142 124 110
6 32 40 98 88 204 180 175 140 124 102
7 25 38 102 86 232 180 200 156 108 90
8 28 35 110 84 260 212 220 158 112 94
9 28 34 120 88 200 178 180 146 106 90
10 32 36 122 86 280 190 210 158 108 88
11 27 38 124 84 260 190 220 162 110 92
12 28 36 112 84 220 174 180 150 112 94
13 28 35 110 82 240 184 210 164 112 90
14 32 40 98 84 170 150 160 134 114 90
15 30 40 102 88 180 155 160 135 116 92
16 31 40 104 82 190 158 175 130 118 92
17 28 36 102 84 220 192 200 170 120 96
18 26 36 106 82 190 158 170 155 122 98
19 26 32 100 80 202 170 192 160 120 102
20 28 34 96 75 180 145 162 130 112 100
21 32 36 102 83 248 194 194 140 108 91
22 30 38 104 83 268 202 212 170 108 90
23 30 34 120 86 242 188 210 150 110 88
24 28 34 122 82 204 178 181 135 120 98
25 26 32 124 84 250 185 193 154 112 90
26 28 37 124 80 260 180 198 145 114 94
27 27 35 112 78 248 168 201 165 118 90
28 29 35 120 82 288 230 216 160 116 94
29 31 40 102 80 278 200 220 160 112 90
30 32 40 106 80 244 190 202 130 118 92
RESULTS:

Table 4.1: Descriptive Statistics of Data

 Descriptive Statistics
Minimu Maximu Std.
N m m Mean Deviation
Age 30 48.00 60.00 54.0333 3.69980
BMI 30 22.14 30.68 26.0273 2.41578
PostmenopausalYear 30 2.00 9.00 4.6667 2.27934
s
PreHDL 30 25.00 32.00 28.7667 2.14449
PostHDL 30 32.00 40.00 36.5333 2.38867
PreLDL 30 96.00 124.00 108.2000 9.41532
PostLDL 30 75.00 90.00 83.9000 3.65164
PreTriglycerides 30 170.00 288.00 228.8000 33.73977
PostTriglycerides 30 145.00 230.00 183.1000 20.42708
PreTotalCholesterol 30 150.00 220.00 191.8333 20.34883
PostTotalCholesterol 30 130.00 170.00 150.7667 12.49740
PreRPP 30 106.00 124.00 113.7333 5.19239
PostRPP 30 88.00 110.00 93.7333 4.94057
Valid N (listwise) 30

Table 4.2: Normality Distribution of Data

 Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
*
Age .130 30 .200 .934 30 .064
*
BMI .078 30 .200 .968 30 .476
PostmenopausalYear .179 30 .015 .893 30 .006
s
PreHDL .206 30 .002 .923 30 .033
PostHDL .155 30 .064 .927 30 .041
PreLDL .206 30 .002 .875 30 .002
PostLDL .156 30 .061 .960 30 .303
PreTriglycerides .136 30 .168 .952 30 .189
PostTriglycerides .101 30 .200* .980 30 .833
PreTotalCholesterol .123 30 .200* .942 30 .101
PostTotalCholesterol .135 30 .169 .945 30 .121
PreRPP .197 30 .004 .924 30 .035
PostRPP .212 30 .001 .845 30 .000
*. This is a lower bound of the true significance.
a. Lilliefors Significance Correction

Table 4.3: Paired Sample t test for pre and post intervention outcome measures –
descriptive statistics
 Paired Samples Statistics
Std. Std. Error
Mean N Deviation Mean
Pair 1 PreHDL 28.7667 30 2.14449 .39153
PostHDL 36.5333 30 2.38867 .43611
Pair 2 PreLDL 108.2000 30 9.41532 1.71899
PostLDL 83.9000 30 3.65164 .66670
Pair 3 PreTriglycerides 228.8000 30 33.73977 6.16001
PostTriglycerides 183.1000 30 20.42708 3.72946
Pair 4 PreTotalCholesterol 191.8333 30 20.34883 3.71517
PostTotalCholester 150.7667 30 12.49740 2.28170
ol
Pair 5 PreRPP 113.7333 30 5.19239 .94800
PostRPP 93.7333 30 4.94057 .90202

Table 4.4: Paired Sample t test for pre and post intervention outcome measures –
Comparison
 Paired Samples Test
Paired Differences
95%
Confidence
Std. Std. Interval of the Sig.
Deviatio Error Difference (2-
Mean n Mean Lower Upper t df tailed)
Pair PreHDL - - 2.28463 .41711 - - - 29 .00001
1 PostHDL 7.76667 8.61976 6.9135 18.620
7
Pair PreLDL - 24.3000 10.3462 1.8889 20.4366 28.163 12.864 29 .00001
2 PostLDL 0 5 6 5 35
Pair PreTriglyceride 45.7000 20.8296 3.8029 37.9221 53.477 12.017 29 .00001
3 s- 0 0 5 0 90
PostTriglycerid
es
Pair PreTotalCholest 41.0666 15.7149 2.8691 35.1985 46.934 14.313 29 .00001
4 erol - 7 9 5 9 74
PostTotalCholes
terol
Pair PreRPP - 20.0000 3.95666 .72238 18.5225 21.477 27.686 29 .000
5 PostRPP 0.001 6 44

Graph 4.1: Demographic Data

 Demographic Data
Demographic Data

54.0333

26.0273

4.6667

Age BMI Post Menopausal Years

Graph 4.2: Pre and Post Test Mean of HDL Values

HDL Values

36.5333

28.7667

Pre Mean Post Mean

Graph 4.3: Pre and Post Test Mean of LDL Values

 LDL Values

108.2

83.9

Pre Mean Post Mean

Graph 4.3: Pre and Post Test Mean of Triglycerides Values

Triglycerides Values

228.8

183.1

Pre Mean Post Mean

Graph 4.4: Pre and Post Test Mean of Total Cholesterol Values
 Total Cholesterol Values

191.8333

150.7667

Pre Mean Post Mean

Graph 4.5: Pre and Post Test Mean of Total Rate Pressure Product Values

Rate Pressure Product Values

113.7333
93.7333

Pre Mean Post Mean

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