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Foot Reflexology Can Increase Vagal Modulation, Decrease Sympathetic Modulation, and Lower Blood Pressure in Healthy Subjects and Patients With Coronary Artery Disease

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  • Tanyu Research Laboratory

Abstract and Figures

Complementary and alternative medicine (CAM) has long been used by people to postpone the aging process and to reverse disease progression. Reflexology is a CAM method that involves massage to reflex areas in the feet and hands. This study investigated the effect of foot reflexology (FR) on the autonomic nervous modulation in patients with coronary artery disease (CAD) by using heart rate variability analysis. Seventeen people with angiographically patent coronary arteries and 20 patients with CAD scheduled for coronary artery bypass graft surgery were recruited as the control and CAD groups, respectively. The normalized high-frequency power (nHFP) was used as the index of vagal modulation and the normalized very low-frequency power (nVLFP) as the index of vagal withdrawal and renin-angiotensin modulation. In both control and CAD groups, the nHFP was increased significantly whereas the nVLFP was decreased significantly 30 and 60 minutes after FR, as compared with those before FR. The systolic, diastolic, mean arterial, and pulse pressures were significantly decreased after FR in both groups of participants. In the CAD group, the percentage change in heart rate 30 and 60 minutes after FR was smaller than that in the control, and the percentage change in nVLFP 60 minutes after FR was smaller than that in the control. In conclusion, a higher vagal modulation, lower sympathetic modulation, and lower blood pressure can be observed following 60 minutes of FR in both controls and CAD patients. The magnitude of change in the autonomic nervous modulation in CAD patients was slightly smaller than that in the controls. FR may be used as an efficient adjunct to the therapeutic regimen to increase the vagal modulation and decrease blood pressure in both healthy people and CAD patients.
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8 ALTERNATIVE THERAPIES, jul/aug 2011, VOL. 17, NO. 4 Foot Reexology in Coronary Artery Disease
Wan-An Lu, MD, PhD, is an assistant professor in the Institute
of Cultural Asset and Reinvention, Fo-Guang University, Ilan,
Taiwan. Gau-Yang Chen, MD, PhD, is an associate professor in
the Institute of Biomedical Engineering, National Yang-Ming
University, Taipei, Taiwan. Cheng-Deng Kuo, MD, PhD, is the
principal investigator in the Biophysics Laboratory in the
Department of Research and Education, Taipei Veterans
General Hospital, Taipei, Taiwan.
Corresponding author: Cheng-Deng Kuo, MD, PhD
E-mail address: cdkuo@vghtpe.gov.tw
Age-related changes in autonomic nervous system
control of the circulation are a key feature of age-
associated cardiovascular disease.1,2 Vagal modula-
tion was found to be decre ased in vari ous
physiological and pathological conditions, such as
aging,3 acute myocardial infarction,4 diabetes mellitus,5 chronic
renal failure,6 congestive heart failure,7 and coronary artery disease
(CAD).8-12 In addition, the reduction in cardiac vagal modulation, as
evaluated by spectral heart rate variability (HRV) analysis, correlat-
ed with angiographic severity, independent of previous myocardial
infarction, location of diseased coronary arteries, and left ventricu-
lar function.12 Vagal stimulation has been shown to have an antiar-
rhythmic effect in animal models of acute ischemia13 ,14 and can
terminate ventricular tachycardia in humans.15 A pharmacological
method of using transdermal scopolamine as a cardiac vagal
enhancer was tried in patients with acute myocardial infarction16-19
and congestive heart failure20 and proved to be effective in improv-
ing the autonomic indices that are associated with high mortality.
However, the safety, tolerability, and efcacy of long-term transder-
mal scopolamine treatment remain to be claried.21
Complementary and alternative medicine (CAM) has long been
used to postpone the aging process and to reverse disease progres-
sion. CAM therapies have lasted because in some cases they work as
well as or better than allopathic medicine. With growing public inter-
est in CAM, it is important for medical professionals to examine the
effectiveness of CAM techniques. Among many therapeutic modali-
ties, reexology is often used as an antiaging CAM technique.22
Reexology is a form of complementary medicine that involves
using massage to reex areas in the feet and the hands.23-26 By stimu-
lating and applying pressure to certain areas, one can increase blood
ORIGINAL RESEARCH
Foot Reexology Can Increase Vagal Modulation,
Decrease Sympathetic Modulation, and Lower Blood
Pressure in Healthy Subjects and Patients With
Coronary Artery Disease
Wan-An Lu, MD, PhD; Gau-Yang Chen, MD, PhD; Cheng-Deng Kuo, MD, PhD
Objective Complementary and alternative medicine (CAM)
has long been used by people to postpone the aging process and
to reverse disease progression. Reexology is a CAM method
that involves massage to reex areas in the feet and hands. This
study investigated the effect of foot reexology (FR) on the
autonomic nervous modulation in patients with coronary
artery disease (CAD) by using heart rate variability analysis.
Study Methods • Seventeen people with angiographically patent
coronary arteries and 20 patients with CAD scheduled for coro-
nary artery bypass graft surgery were recruited as the control and
CAD groups, respectively. The normalized high-frequency power
(nHFP) was used as the index of vagal modulation and the nor-
malized very low-frequency power (nVLFP) as the index of vagal
withdrawal and renin-angiotensin modulation.
Results • In both control and CAD groups, the nHFP was
increased signicantly whereas the nVLFP was decreased sig-
nicantly 30 and 60 minutes after FR, as compared with those
before FR. The systolic, diastolic, mean arterial, and pulse pres-
sures were signicantly decreased after FR in both groups of
participants. In the CAD group, the percentage change in heart
rate 30 and 60 minutes after FR was smaller than that in the
control, and the percentage change in nVLFP 60 minutes after
FR was smaller than that in the control. In conclusion, a higher
vagal modulation, lower sympathetic modulation, and lower
blood pressure can be observed following 60 minutes of FR in
both controls and CAD patients. The magnitude of change in
the autonomic nervous modulation in CAD patients was slight-
ly smaller than that in the controls.
Conclusion • FR may be used as an efcient adjunct to the
therapeutic regimen to increase the vagal modulation and
decrease blood pressure in both healthy people and CAD
patients. (Altern Ther Health Med. 2011;17(4):8-14.)
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ALTERNATIVE THERAPIES, jul/aug 2011, VOL. 17, NO. 4 9
Foot Reexology in Coronary Artery Disease
circulation and promote specic bodily and muscular functions. It
has been estimated that more than 20 million Americans have seen
reports of the effectiveness of reexology on television and have read
about this natural technique of healing in national magazines and
newspapers.23 Several books have been written to propagate the reju-
venation effects of reexology.24-26 Though Wang et al27 reviewed ve
studies of reexology in the literature and concluded that there is no
evidence for any specic effect of reexology in any conditions with
the exception of urinary symptoms associated with multiple sclerosis,
others have shown signicant effects using reexology. The feet are
the most common areas treated with reexology.24 Sudmeier et al28
showed that foot reexology (FR) is effective in changing renal blood
flow. Stephenson et al29,30 have shown that FR can relieve pain in
patients with metastatic cancer and decrease anxiety in patients with
breast and lung cancer. Ergonomically created footwear also has been
invented to provide relaxation, reduce swelling, induce blood ow,
and rejuvenate the muscles and nerves in the ankle and foot area.31
Since patients with anxiety or pain are expected to have an ele-
vated sympathetic and a depressed vagal modulation,32,33 it is possi-
ble that treatment with FR can lower sympathetic modulation and
raise vagal modulation. It is therefore worthy of investigating wheth-
er FR can have an effect on the autonomic nervous modulation in
normal controls and in patients with CAD.
MATERIALS AND METHODS
Study Participants
Coronary arteriography was performed in patients with angina
pectoris, unstable angina, previous myocardial infarction, or other
evidence of myocardial ischemia. A panel of cardiologists interpreted
the angiograms. The coronary arteries and branches were divided
into 15 segments according to the Ad Hoc Committee for Grading of
Coronary Artery Disease of the American Heart Association.34 Only
the luminal narrowing in the following segments was used in the
nal assessment: segment 1-3 for the right coronary artery, segments
6 and 7 for the left anterior descending branch, segments 11 and 12
for the circumex branch, and segment 5 for the left main coronary
artery. By conning the analysis to these segments alone, only those
patients who had signicant obstruction in the main epicardial coro-
nary arteries were included in this study. Stenosis was considered to
be signicant if a luminal narrowing >50% was present. Patients
without stenosis or with luminal narrowing <30% were classied as
the control group. Coronary artery bypass graft surgery was suggest-
ed for patients who refused percutaneous coronary intervention or
whose lesions were not suitable for it. Patients with CAD preparing
for coronary artery bypass graft surgery were recruited as the study
group. Patients with angiographically patent coronary arteries were
recruited as the control group. Hypertension was dened as systolic
blood pressure >140 mmHg or diastolic blood pressure >90 mmHg.35
Hyperlipidemia was dened as total cholesterol >200 mg/dL or low
density lipoprotein cholesterol >100 mg/dL.36 Patients who had atri-
al brillation or coexisting valvular heart disease or were using class I
antiarrhythmic medication were excluded from this study. All par-
ticipants were requested to refrain from alcohol or caffeine ingestion
24 hours before the study. The hospital Institutional Review Board
approved this study. The procedure was fully explained to the partic-
ipants, and written informed consent was obtained from them
before the study.
Equipment
The electrocardiogram (ECG) signals were recorded using a
multichannel recorder (Biopac MP150 with 16 channels, MP150CE/
UIM100C/ECG100C, BIOPAC Systems, Inc, Goleta, California) from
conventional lead II, and blood pressure was measured by using a
sphygmomanometer (Kenlu-model K-300 Sphygmomanometer, Di
Tai Precision Ent Co Ltd, Kaohsiung City, Taiwan) on each partici-
pant lying in a supine position. The analog signals of ECG were
transformed to digital signals by using an analog-to-digital converter
with a sampling rate of 400 Hz. Systolic blood pressure (SBP), dia-
stolic blood pressure (DBP), mean arterial blood pressure (MABP),
and pulse pressure (PP) were obtained from each participant before
FR using the sphygmomanometer.
Study Protocol
Before FR, each participant rested in a supine position for 5
minutes, and then 10 minutes of continuous ECG signals and blood
pressure data were recorded. After baseline ECG recording and
blood pressure measurement, the participant received FR for 60
minutes. The ECG recording and blood pressure measurements
were repeated 30 and 60 minutes after FR. All procedures were per-
formed in a bright and quiet room with a room temperature of 24 oC
to 25oC and humidity of 54% to 55%.
FR was performed on participants lying in a comfortable
supine position by a certified foot reflexologist from the Taiwan
Association of Reexology using the techniques of Father Josef ’s
FR.37 The reexologist used the thumb and ngers to apply pressure
to stimulate all reex zones in both feet, which correspond to all
organs, glands, and body parts. The technique of the thumb and n-
gers resembles a caterpillar-like action in reexology.38 Grapeseed oil
is used during FR to prevent friction and possible discomfort because
it is nonsticky and odorless and absorbs easily into the skin.39,40
Heart Rate Variability Analysis
R-wave–detecting software written with the help of Matlab R13
software (MathWorks Inc, Natick, Massachusetts) was used to iden-
tify the peaks of the R waves in the recorded ECG signals. The RR
intervals (the time intervals between two consecutive R waves in the
electrocardiogram, RRI) were then calculated after eliminating ecto-
pic beats. If the percentage of ectopic beats was greater than 5%, then
the participant was excluded from analysis. The last 512 stationary
RRI were used for HRV analysis.
The mean, standard deviation (SDRR) and coefcient of varia-
tion (CVRR) of the 512 stationary RRI were calculated using a stan-
dard formula for each participant. The power spectra of RRI were
obtained by means of fast Fourier transformation (Mathcad,
Mathsoft Inc, Cambridge, Massachusetts). Direct current compo-
nent was excluded before the calculation of the powers. The area
under the curve of the spectral peaks within the range of 0.01-0.4 Hz,
0.01-0.04 Hz, 0.04-0.15 Hz, and 0.15-0.40 Hz were dened as the
10 ALTERNATIVE THERAPIES, jul/aug 2011, VOL. 17, NO. 4 Foot Reexology in Coronary Artery Disease
total power (TP), very low–frequency power (VLFP), low-frequency
power (LFP), and high-frequency power (HFP), respectively.
The Task Force of the European Society of Cardiology and the
North American Society of Pacing Electrophysiology have suggested
that the power within the frequency range of 0.04-0.4 Hz be used for
the normalization of LFP and HFP.41 Since this frequency range cov-
ers only the frequency ranges of LFP and HFP but not VLFP, it may
not be suitable for the normalization of VLFP. Therefore, we used
the power within the frequency range of 0.01-0.4 Hz, which covers
the frequency ranges of VLFP, LFP, and HFP, to normalize VLFP,
LFP, and HFP in this study. The normalized very low-frequency
power (nVLFP
=
VLFP/TP) was then used as the index of vagal with-
drawal, renin-angiotensin modulation, and thermoregulation42-44; the
normalized low-frequency power (nLFP
=
LFP/TP) was used as the
index of combined sympathetic and vagal modulation45; the normal-
ized high-frequency power (nHFP
=
HFP/TP) was used as the index
of vagal modulation; and the low-/high-frequency power ratio (LFP/
HFP) was used as the index of sympathovagal balance.46
Statistical Analysis
Values of HRV and blood pressure measures were presented as
median (25 percentile
-75 percentile). Friedman repeated measures
analysis of variance on ranks (SigmaStat statistical software, Jandel
Scientic, San Rafael, California) was employed to compare the HRV
and blood pressure measures among before FR, 30 minutes after FR,
and 60 minutes after FR. Signicant difference was further analyzed
by pairwise comparison using the Student Newman–Keuls test. The
Mann-Whitney rank sum test was employed to compare the HRV
and blood pressure measures between CAD patients and controls.
To correct for baseline differences on the comparison of HRV
and blood pressure measures between CAD patients and controls,
the percentage changes in HRV and blood pressure measures in each
participant 30 and 60 minutes after FR were calculated using the fol-
lowing formulas:
%C30 = [(C30 min -Cbefore)/(Cbefore)]×100
%C60 = [(C60 min -Cbefore)/(Cbefore)]×100,
where X represents the variable to be compared. The Mann-Whitney
rank sum test was used to compare %C30 and %C60 between con-
trols and patients with CAD. Wilcoxon signed rank test was
employed to compare %C30 with %C60 in both controls and
patients with CAD. A P
<
.05 was considered statistically signicant.
RESULTS
General Characteristics
The percentage of deletion of ectopic beats due to atrial or ven-
tricular arrhythmia was >5% in two patients in the CAD group and
three participants in the control group. Thus, only 20 out of 22
patients in the CAD group and 17 out of 20 patients in the control
group were included in the nal statistical analysis. Table 1 shows
the baseline characteristics of the control and CAD groups. There
were 17 men and 3 women (between 52.5 and 66.0 years of age with
an average of 62.0 years) in the CAD group and 15 men and 2
women (between 52.0 and 66.0 years of age with an average of 56.0
years) in the control group.
Effect of Foot Reexology on Blood Pressure
Table 2 shows the sequential changes in blood pressures after
FR in both groups of participants. The SBP, DBP, and MABP
decreased signicantly after FR in both groups. The PP decreased 30
minutes after FR in both groups and elevated to pre-FR level 60 min-
utes after FR in the control group.
Table 3 shows the percentage changes in blood pressures after
RF in both groups of participants. In the control group, the percent-
age decrease in SBP and PP 30 minutes after FR was larger than that
60 minutes after FR. In the CAD group, the percentage decrease in
PP 30 minutes after FR was larger than that of 60 minutes after FR.
No signicant difference in the percentage change in blood pressures
after FR was found between the two groups.
Effect of Foot Reexology on Heart Rate Variability
Table 4 shows the effects of FR on the time and frequency
domain HRV measures in patients with CAD and control group.
TABLE 1 Baseline Characteristics of the Control and Coronary
Artery Disease (CAD) Groups*
Control Group (n = 17) CAD Group (n = 20) P value
Age (y) 56.0 (52.0-66.0) 62.0 (52.5-66.0) NS
Gender (M/F) 15/2 17/3 NS
Body height (cm) 161.0 (156.0-164.3) 163.5 (157.0-173.0) NS
Body weight (kg) 59.0 (51.5-70.3) 64.0 (58.3-74.5) NS
BMI (m2/kg) 22.2 (21.1-25.0) 24.1 (22.2-26.4) NS
History
Previous MI 0 4 NA
Hypertension 12 15 NS
Diabetes mellitus 6 7 NS
Hyperlipidemia 6 7 NS
Current smoker 7 11 NS
Medication
Beta-blocker 10 15 NS
Calcium antagonist 11 17 NS
Nitrates 13 19 NS
ACE inhibitor 6 10 NS
ARB 1 3 NS
Digitalis 1 1 NS
Aspirin 12 18 NS
Clopidogrel 5 10 NS
Ticlopidine 2 4 NS
Clinical status
One-vessel disease 0 8 NA
Two-vessel disease 0 8 NA
Three-vessel disease 0 4 NA
Left main disease 0 5 NA
Left ventrical aneurysm 0 4 NA
*Values are numbers of patients or medians (25-75 percentile).
Abbreviations: BMI, body mass index; ACE, angiotensin-converting enzyme;
ARB, angiotensin receptor blocker; MI, myocardial infarction; NS, not signi-
cant (P > .05); NA, not assessed.
ALTERNATIVE THERAPIES, jul/aug 2011, VOL. 17, NO. 4 11
Foot Reexology in Coronary Artery Disease
Thirty and 60 minutes after RF, the nHFP was signicantly increased,
whereas the nVLFP was signicantly decreased in both groups of
participants s as compared with those before RF. The VLFP and TP
after FR were signicantly decreased in the control group. The mean
RRI was signicantly increased, and the heart rate was signicantly
decreased after RF in CAD patients. Although the SDRR, TP, VLFP,
LFP, and HFP of the CAD patients before FR were not signicantly
different from those of the controls, they were signicantly larger
than those of the controls 60 minutes after FR. However, the relative
HRV measures including nVLFP, nLFP, nHFP and LFP/HFP were
not signicantly different between the controls and the CAD patients
both before FR and 60 minutes after FR.
Table 5 shows the percentage changes in HRV measures after RF
in both groups of participants. The percentage decrease in SDRR, TP,
VLFP, and LFP and the percentage increase in heart rate 60 minutes
after FR were larger than those of 30 minutes after FR in controls.
There were no signicant differences in the percentage changes in all
HRV measures between 30 minutes and 60 minutes after FR in the
CAD patients.
The percentage increase in mean RRI 30 minutes after FR in the
CAD group was larger than that in the control group, whereas the per-
centage decrease in heart rate 30 minutes after FR in the CAD group
was smaller than that in the control group. Similarly, the percentage
increase in mean RRI, SDRR, TP, VLFP, LFP, and HFP in the CAD
group 60 minutes after FR was larger than those in the control group,
whereas the percentage decrease in heart rate and nLFP in the CAD
group 60 minutes after FR was smaller than those in the control group.
Effect of Beta-blockers on Heart Rate Variability
Table 6 shows that there were no signicant differences in all
HRV measures between participants using or not using beta-block-
ers in either control or CAD group and between the control and
CAD groups whether they were using beta-blockers or not. There are
no differences in the effects of FR on patients whether they were
using or not using beta-blocker medication.
DISCUSSION
Ludwig has defined aging as a time-dependent, irreversible
shift from environmental to intrinsic causation of disease.47 This
intrinsic pathogenesis has two components: the rst one is genetic
and beyond the reach of contemporary health care and the second
one entails the growing number of degenerative lesions due to viral
agents as well as carcinogenesis. Bonnemeier et al have shown that
normal aging is associated with a constant decline of cardiac vagal
modulation due to a signicant decrease of nocturnal parasympa-
thetic activity.48 It has also been shown that depressed vagal modula-
tion is associated increased risk of sudden death in patients with
CAD, and the experimental evidence also suggests a causal
relationship.49-52 With the adverse prognostic implication of reduced
cardiac vagal activity in its susceptibility to life-threatening
arrhythmia,51-53 any intervention that can enhance the vagal modula-
tion will be benecial to patients, especially for those at high risk for
life-threatening arrhythmia. Exercise and medication have been found
to increase the vagal modulation of the study participants,16-20,53-55,
TABLE 2 Effect of Foot Reexology (FR) on Blood Pressure*
Before FR 30 Min After FR 60 Min After FR
Control group (n = 17)
SBP (mmHg) 136.0 (129.8-141.8) 115.0 (109.8-123.3)‡ 124.0 (114.0-133.5)‡§
DBP (mmHg) 75.0 (72.8-80.3) 67.0 (63.0-73.3)‡ 67.0 (62.8-75.0)‡
MABP (mmHg) 95.0 (87.5-101.3) 83.0 (78.3-88.0)‡ 84.0 (79.8-86.8)‡
PP (mmHg) 60.0 (54.3-65.0) 48.0 (45.5-52.3)‡ 54.0 (47.8-61.3)§
CAD group (n = 20)
SBP (mmHg) 153.5 (139.5-163.5)† 134.5 (123.0-148.0)†‡ 134.0 (125.5-147.0)†‡
DBP (mmHg) 84.5 (78.0-93.0)† 80.5 (70.5-84.5)† 75.5 (69.5-85.0)†‡
MABP (mmHg) 102.0 (95.5-113.0)† 96.5 (88.5-104.0)† 94.0 (85.0-99.0)†‡
PP (mmHg) 64.0 (60.0-72.0) 50.5 (46.5-66.5)‡ 57.0 (53.0-64.0)‡
*Values presented are medians (25-75 percentile).
P < .05 between controls and patients with CAD.
P < .05 vs before FR.
§P < .05 vs 30 min after FR.
Abbreviations: CAD, coronary artery disease; SBP, systolic blood pressure; DBP, diastolic blood pressure; MABP, mean arterial blood pressure; PP, pulse pressure.
TABLE 3 Percentage Changes in Blood Pressure After
Foot Reexology*
%X30 %X60
Control group (n = 17)
SBP; %
DBP; %
MABP; %
PP; %
CAD group (n = 20)
SBP; %
DBP; %
MABP; %
PP; %
–15.2 (–18.5 to –8.3)
–5.5 (–8.2 to –3.7)
–11.0 (–16.8 to –6.9)
–15.9 (–26.7 to –10.8)
–10.2 (–14.6 to –3.8)
–8.1 (–12.4 to 0.0)
–5.6 (–14.0 to –0.1)
–13.5 (–23.7 to –5.3)
–8.3 (–12.5 to –2.8)†
–8.1 (–14.3 to –4.1)
–9.3 (–16.7 to –3.8)
–8.5 (–16.1 to –1.2)†
–6.6 (–14.1 to –3.1)
–8.1 (–9.7 to –4.4)
–7.3 (–12.5 to –4.1)
–9.1 (–16.7 to 1.7)†
*Values presented are medians (25-75 percentile).
P < .05 vs %X30.
Abbreviations: CAD, coronary artery disease; SBP, systolic blood pressure;
DBP, diastolic blood pressure; MABP, mean arterial blood pressure; PP,
pulse pressure.
12 ALTERNATIVE THERAPIES, jul/aug 2011, VOL. 17, NO. 4 Foot Reexology in Coronary Ar tery Disease
but this study showed that foot reexology can also increase vagal
modulation.
Reexology is the study of working on the specic reex points
(areas) on the hands, feet, and ears that mirror the whole body in
order to relax and relieve stress and pain.23-26 In clinical terms, reex-
ology is the application of pressure, primarily but not limited to the
feet, hands, or ears, that causes a physiological response in the body.
Many studies have examined the efcacy of reexology. However,
controversy existed regarding efficacy of reflexology.27,56-60 Frankel
found that the frequency of sinus arrhythmia after reexology and
FM was increased by 43.9% and 34.1%, respectively; he suggested a
“neuro theory” whereby reflexology and foot massage alter the
baroreceptor reex sensitivity by stimulating the sensory nervous
system in the feet.56 Hattan et al have investigated the impact of foot
massage and guided relaxation on the well-being of patients who had
undergone coronary artery bypass graft surgery and demonstrated
that these interventions appear to be effective noninvasive tech-
niques for promoting psychological well-being in this patient group.57
Some studies have pointed out that reexology possesses the poten-
tial to provide relief of pain and symptoms and induce
relaxation.25,58,59 Hayes and Cox60 also demonstrated that a 5-minute
foot massage had the potential effect of increasing relaxation as evi-
denced by a signicant decrease in heart rate, blood pressure, and
respiration during the brief foot massage intervention administered
to critically ill patients in intensive care.
In this study, we found that FR results in positive effects on
blood pressure and autonomic nervous modulation in both control
group and patients with CAD. The nHFP was signicantly increased
after FR, whereas the nVLFP and LFP/HFP were significantly
decreased after FR, in both control and CAD groups. This result sug-
gested that a higher vagal modulation, lower sympathetic modula-
tion, renin-angiotensin modulations and thermoregulatory activity
can be observed following 60 minutes of FR in both angiographically
patent controls and CAD patients. However, the increase in mean
RRI, SDRR, TP, VLFP, LFP, and HFP in the CAD group 60 minutes
after FR was still present, whereas these measures were decreased in
the control group 60 minutes after FR (Table 4). It seems that the ben-
ecial effect of FR on HRV measures, especially on those measures
TABLE 4 Effect of Foot Reexology (FR) on Heart Rate Variability Measures (HRV)*
Before FR 30 Min After FR 60 Min After FR
Control group (n = 17)
Mean RRI (ms) 861.9 (781.3-948.7) 839.5 (776.0-981.0) 827.0 (765.7-921.6)
Heart rate (bpm) 69.6 (63.2-76.8) 71.5 (61.2-77.3) 72.6 (65.1-78.4)
SDRR (ms) 52.3 (48.5-60.3) 48.1 (45.6-57.7) 44.8 (42.3-49.5)
CVRR (%) 6.0 (5.4-6.6) 5.9 (5.4-6.4) 5.4 (5.3-6.0)
TP (ms2) 946 (784-1428) 808 (642-1242) 640 (552-866)‡§
VLFP (ms2) 312 (186-497) 226 (135-385)‡ 135 (106-179)‡§
LFP (ms2) 251 (172-406) 206 (152-390) 188 (153-276)
HFP (ms2) 369 (311-547) 390 (286-532) 344 (268-428)
nVLFP (nu) 33.1 (28.4-41.9) 27.8 (19.0-33.8)‡ 20.2 (14.5-26.1)‡
nLFP (nu) 28.3 (20.5-29.4) 26.9 (23.7-29.0) 29.0 (25.6-32.5)
nHFP (nu) 38.6 (33.4-46.2) 47.2 (40.9-55.0)‡ 50.7 (43.7-54.5)‡§
LFP/HFP 0.71 (0.53-0.82) 0.61 (0.51-0.66) 0.59 (0.49-0.67)
CAD group (n = 20)
Mean RRI (ms) 831.1 (762.3-903.0) 917.5 (849.7-928.6)‡ 911.0 (861.6-922.4)‡
Heart rate (bpm) 72.2 (66.5-78.7) 65.4 (64.6-70.6)‡ 65.9 (65.1-69.6)‡
SDRR (ms) 52.6 (45.2-62.5) 53.5 (49.4-66.6) 55.2 (49.6-60.7)†
CVRR (%) 6.3 (5.5-7.2) 6.0 (5.5-7.1) 5.8 (5.4-6.5)
TP (ms2) 981 (694-1526) 979 (886-1630) 1134 (931-1499)†
VLFP (ms2) 257 (174-545) 233 (163-398) 212 (153-346)†
LFP (ms2) 271 (208-491) 293 (278-407) 322 (259-449)†
HFP (ms2) 470 (277-555) 515 (413-648) 527 (457-732)†
nVLFP (nu) 30.6 (24.9-32.9) 23.5 (17.7-29.0)‡ 20.0 (14.2-29.0)‡
nLFP (nu) 28.4 (25.8-31.5) 29.2 (28.1-31.7) 29.5 (27.4-30.7)
nHFP (nu) 42.8 (34.8-46.3) 46.4 (40.9-50.9)‡ 52.1 (42.9-55.4)‡
LFP/HFP 0.66 (0.53-0.83) 0.62 (0.52-0.77) 0.57 (0.52-0.66)
*Values presented are medians (25-75 percentile).
P < .05 between normal controls and patients with CAD.
P < .05 vs before FR.
§P < .05 vs 30 min after FR.
Abbreviations: CAD, coronary artery disease; RRI, RR intervals; SDRR, standard deviation of RR; CVRR, coefcient of variation of RR; TP, total power; VLFP, very
low-frequency power; LFP, low-frequency power; HFP, high-frequency power; nVLFP, normalized very low-frequency power; nLFP, normalized low-frequency power;
nHFP, normalized high-frequency power; LFP/HFP, low-/high-frequency power ratio.
ALTERNATIVE THERAPIES, jul/aug 2011, VOL. 17, NO. 4 13
Foot Reexology in Coronary Artery Disease
related to vagal modulation, last longer in patients with CAD than in
the controls. The mechanism responsible for this differential effect
was not clear at present because it was not investigated in this study.
We speculate that the FR-related autonomic nervous effect of increas-
ing vagal and decreasing sympathovagal balance may be more evi-
dent in those patients who have depressed vagal modulation and
enhanced sympathetic modulation, such as patients with CAD.
Further studies are needed to disclose the underlying mechanism.
Other considerations include that the manipulation of FR on a
participant did not allow him or her to rest uninterruptedly. Thus, a
participant not receiving FR is not a good control to contrast the
effect of FR on that person. If a control is going to be used to contrast
the effect of FR, manipulating some area other than the foot that has
no reex points on it for the same period of time may be a better
choice than a participant not receiving FR. According to the tradi-
tional Oriental medicine, no area over the whole body can be found
that can be stimulated by pressure and massage without causing a
physiological response in the body. Therefore, the participant not
receiving FR in either group was not designed as a control to contrast
the effect of FR in this study.
To know the differences in the effects of FR on patients who are
on different medications and the effects of those medications on FR,
we chose to compare the effect of beta-blockers on the HRV mea-
sures in both control and CAD groups. We found that there were no
signicant differences in all HRV measures between participants
using or not using beta-blockers in either control or CAD group and
between the control and CAD groups whether they were using beta-
blockers or not (Table 6). Thus, there are no differences in the effects
of FR on CAD patients whether or not they are on beta-blocker medi-
cation, and the beta-blockers do not signicantly inuence the effect
of FR on the autonomic nervous modulation of the participants.
In conclusion, a higher vagal modulation, lower sympathetic
modulation, and lower blood pressures can be observed following 60
minutes of FR in both angiographically patent controls and CAD
patients. Though the magnitude of change in the autonomic nervous
modulation of the CAD patients was slightly smaller than that of the
controls, FR is a complementary therapeutic method to allopathic
medical care that is simple and safe for almost everyone. FR requires
very little time and expense, no special equipment, and no medica-
tion and can be performed practically anywhere. Since the mortality
risk due to acute myocardial infarction is lower in patients with higher
vagal modulation and is higher in patients with higher sympathetic
modulation, our research suggests that FR is a safe, low-cost adjunct
TABLE 5 The Percentage Changes in Heart Rate Variability
Measures After Foot Reexology*
%X30 %X60
Control group (n = 17)
Mean RRI; % –0.6 (–4.0 to 4.8)‡ –4.2 (–9.1 to 0.9)
Heart rate; % 0.6 (–4.6 to 4.0)‡ 4.3 (–0.8 to 10.0)‡
SDRR; % 0.0 (–10.4 to 6.5) –13.3 (–17.6 to –1.2)‡
CVRR; % –0.5 (–8.7 to 8.1) –4.6 (–12.5 to 1.1)
TP; % –5.7 (–21.9 to 18.4) –28.0 (–36.0 to –8.4)‡
VLFP; % -12.2 (–38.6 to 3.6) –56.0 (–69.8 to –33.9)‡
LFP; % 0.0 (–15.7 to 19.1) –23.2 (–39.6 to 13.3)‡
HFP; % 3.6 (–9.1 to 30.2) –6.9 (–30.0 to 13.0)
nVLFP; % –9.3 (–42.5 to 1.1) –37.3 (–49.6 to –26.5)
nLFP; % 1.0 (–9.2 to 24.7) 14.1 (–2.9 to 23.5)
nHFP; % 9.9 (–0.0 to 41.3) 18.0 (7.8 to 52.0)
LFP/HFP; % –14.3 (–28.5 to 16.6) –5.7 (–23.2 to 7.9)
CAD group (n = 20)
Mean RRI; % 6.6 (3.1 to 11.1)† 10.9 (3.5 to 17.7)†
Heart rate; % –6.2 (–10.0 to –3.1)† –9.9 (–15.0 to –3.4)†
SDRR; % 4.3 (–8.7 to 23.7) 3.8 (–6.6 to 11.0)†
CVRR; % 0.0 (–12.8 to 12.4) –6.0 (–10.4 to –2.0)
TP; % 11.3 (–25.1 to 58.9) 14.5 (–13.3 to 38.5)†
VLFP; % –0.3 (–39.9 to 21.6) –14.5 (–40.6 to 10.3)†
LFP; % 7.6 (–22.3 to 72.8) 13.8 (–6.7 to 40.7)†
HFP; % 10.0 (–13.2 to 53.3) 32.4 (6.0 to 59.2)†
nVLFP; % –16.4 (–28.2 to –2.9) –18.4 (–40.6 to –4.5)
nLFP; % 0.5 (–6.7 to 7.1) 2.0 (–5.1 to 11.7)†
nHFP; % 8.9 (0.0 to 25.9) 15.1 (1.3 to 33.1)
LFP/HFP; % –11.2 (–23.3 to 2.1) –9.1 (–31.5 to 3.7)
*Values presented are medians (25-75 percentile).
P < .05 between normal controls and patients with CAD.
P < .05 vs before FR.
§P < .05 vs 30 min after FR.
Abbreviations: CAD, coronary artery disease; RRI, RR intervals; SDRR, stan-
dard deviation of RR; CVRR, coefcient of variation of RR; TP, total power;
VLFP, very low-frequency power; LFP, low-frequency power; HFP, high-fre-
quency power; nVLFP, normalized very low-frequency power; nLFP, normal-
ized low-frequency power; nHFP, normalized high-frequency power; LFP/HFP,
low-/high-frequency power ratio.
TABLE 6 Effect of Beta-blockers on Heart Rate Variability in the
Control and Coronary Artery Disease (CAD) Groups*
Control Group (n = 17) CAD Group (n = 20)
Without beta-blockers (n = 12)
TP (ms2) 861.6 (696.0-9876.9) 1415.0 (467.0-2036.0)
VLFP (ms2) 312.0 (176.2-406.9) 218.0 (165.3-733.0)
LFP (ms2) 174.5 (158.5-255.1) 382.0 (127.7-641.2)
HFP (ms2) 373.3 (228.2-493.5) 460.5 (194.4-927.8)
nVLFP (nu) 36.0 (24.3-41.9) 31.2 (26.2-37.7)
nLFP (nu) 23.8 (20.2-29.2) 28.2 (26.4-31.3)
nHFP (nu) 42.9 (35.4-48.1) 37.7 (33.2-48.6)
LFP/HFP 0.53 (0.48-0.81) 0.82 (0.52-0.90)
With beta-blockers (n = 25)
TP (ms2) 1083.1 (827.2-2104.0) 962.5 (7484.1-1375.0)
VLFP (ms2) 311.9 (197.5-514.1) 288.4 (173.8-444.4)
LFP (ms2) 337.1 (177.9-413.1) 256.8 (219.4-437.9)
HFP (ms2) 354.1 (318.7-625.3) 480.2 (318.4-546.6)
nVLFP (nu) 33.0 (30.3-41.3) 30.5 (24.1-32.7)
nLFP (nu) 28.3 (21.5-30.1) 28.6 (25.2-32.4)
nHFP (nu) 38.5 (32.6-44.0) 43.2 (35.5-46.2)
LFP/HFP 0.74 (0.59-0.81) 0.65 (0.53-0.82)
*Values presented are medians (25-75 percentile).
Abbreviations: TP, total power; VLFP, very low-frequency power; LFP, low-
frequency power; HFP, high-frequency power; nVLFP, normalized very low-
frequency power; nLFP, normalized low-frequency power; nHFP, normalized
high-frequency power; LFP/HFP, low-/high-frequency power ratio.
14 ALTERNATIVE THERAPIES, jul/aug 2011, VOL. 17, NO. 4 Foot Reexology in Coronary Artery Disease
treatment that can be used as an effective physiological vagal enhanc-
er and sympathetic suppressor in both control and CAD patients to
benet cardiovascular health.
Acknowledgments
This study was supported by the project VGHUST93-P1-08 of the Joint Research Program of
Veterans General Hospital and University System, Taiwan, and the project CCMP97-RD047 of the
Committee on Chinese Medicine and Pharmacy, Department of Health, Taipei, Taiwan.
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... Foot reflexology is a simple inexpensive non-invasive procedure which can be used everywhere without any need for specific equipment and without disturbing patient privacy [33]. Previous studies reported the positive effects of foot reflexology on the quality of sleep, blood pressure, and anxiety in patients with coronary diseases [34][35][36]. Also, the positive effects of this intervention have been shown on pain intensity in patients with low back pain [30,37]. ...
... Previous research has shown that foot reflexology before CA can lead to improvements in the stress and vital signs of patients, including decreased diastolic blood pressure, heart rate, and respiratory rate [66]. Also, foot reflexology has been identified as a useful adjunct to the therapeutic regimen to decrease blood pressure in CAD patients [35]. Finally, this intervention could improve anxiety and sleep quality in CAD patients [34,36]. ...
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... The acute effects of reflexology massage on blood pressure, heart rate (HR) patterns, and salivary cortisol concentration have been reported [10,11]. Lu, Chen and Kuo [12] demonstrated that vagal activation was increased while sympathetic modulation and arterial blood pressure were decreased after a 60min foot reflexology massage (FRM). The physiological changes in autonomic nervous function are due to the enhancement of vagal tone modulation via stimulating a neural baroreflex during the FRM intervention. ...
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Foot reflexology massage (FRM) has positive effects on cardiovascular and haemodynamic functions. However, information regarding the physiological changes after FRM post exercise-stress is limited. This study investigated the acute effects of FRM on heart rate variability (HRV) after the repeated sprint ability (RSA) test and the Yo-Yo Intermittent Recovery Test Level 1 (YY). Twenty-six collegiate male football players were randomly assigned to the FRM group (n = 14) or to the control group (n = 12). Electrocardiographic (ECG) signals were recorded for 15 min in supine position before and after the intervention/control period in the RSA test and the YY test. In comparison to the control group, the FRM group demonstrated higher values of root mean squared successive difference in the RR interval (RMSSD; p = 0.046, ES = 0.76) and in the proportion of differences of adjacent RR intervals >50 ms (pNN50; p = 0.031, ES = 0.87); and higher percent changes in mean RR interval (%MeanRR; p = 0.040, ES = 0.99), standard deviation of RR intervals (%SDNN; p = 0.008, ES = 1.10), normalised high-frequency power (%nHFP; p = 0.008, ES = 0.77), total power (%TP; p = 0.009, ES = 0.84) and standard deviation 1 and 2 (%SD1; p = 0.008, ES = 1.08, %SD2; p = 0.020, ES = 1.04) after the RSA test. The magnitude effect of post-exercise HRV was small after the FRM RSA protocol (ES = 0.32-0.57). Conversely, the results demonstrated a moderate and large magnitude effect of HRV in the RSA and YY protocols of the control group (ES: RSA = 1.07-2.00; YY = 0.81-1.61) and in the YY protocol of the FRM group (ES = 0.99-1.59). The FRM intervention resulted in beneficial effects on the cardiac parasympathetic reactivity and the sympatho-vagal balance after RSA performance.
... This could be due to the movements in yoga stimulating the vagus nerve and balancing the autonomic nervous system activity [53]. Self-massage might also elicit these physiological effects [54]. Mindful breathing practices are another self-soothing method used for reducing levels of anxiety. ...
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Anxiety disorders affect approximately one third of people during their lifetimes and are the ninth leading cause of global disability. Current treatments focus on therapy and pharmacological interventions. However, therapy is costly and pharmacological interventions often have undesirable side-effects. Healthy people also regularly suffer periods of anxiety. Therefore, a non-pharmacological, intuitive, home intervention would be complementary to other treatments and beneficial for non-clinical groups. Existing at-home anxiety aids, such as guided meditations, typically employ visual and/or audio stimuli to guide the user into a calmer state. However, the tactile sense has the potential to be a more natural modality to target in an anxiety-calming device. The tactile domain is relatively under-explored, but we suggest that there are manifold physiological and affective qualities of touch that lend it to the task. In this study we demonstrate that haptic technology can offer an enjoyable, effective and widely accessible alternative for easing state anxiety. We describe a novel huggable haptic interface that pneumatically simulates slow breathing. We discuss the development of this interface through a focus group evaluating five prototypes with embedded behaviours (‘breathing’, ‘purring’, ‘heartbeat’ and ‘illumination’). Ratings indicated that the ‘breathing’ prototype was most pleasant to interact with and participants described this prototype as ‘calming’ and ‘soothing’, reminding them of a person breathing. This prototype was developed into an ergonomic huggable cushion containing a pneumatic chamber powered by an external pump allowing the cushion to ‘breathe’. A mixed-design experiment (n = 129) inducing anxiety through a group mathematics test found that the device was effective at reducing pre-test anxiety compared to a control (no intervention) condition and that this reduction in anxiety was indistinguishable from that of a guided meditation. Our findings highlight the efficacy of this interface, demonstrating that haptic technologies can be effective at easing anxiety. We suggest that the field should be explored in more depth to capture the nuances of different modalities in relation to specific situations and trait characteristics.
... These effects cause changes in heart rate and variations in baroreceptor reflexes (105)(106)(107)(108). Reflexology specifically increases blood pressure. These changes can be useful in promoting healing and increasing the capacity of human organisms to respond to internal and external challenges (109)(110)(111)(112). ...
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Aim: this study was conducted to review the related articles and draw a final conclusion regarding the application of reflexology for delivery (labor and cesarean section) pain management in woman all over the world. Methodology: In this systematic review, relevant articles were searched in Google Scholar, PubMed, Cochrane Library, Science Direct, and Scopus databases from the year 2000 to 2018. All the human clinical trials that examined the effects of reflexology methods on delivery pain (labor or Cesarean section) were included and others excluded from the study. Results: All the 18 included original articles (with 1391 patients) reported that reflexology significantly reduces the pain of delivery, confirming its decreasing effect on labor, Cesarean section, and post-delivery pain. Results of all articles showed that, if true reflexology is performed on the right location of the body and at the appropriate time, the pain of delivery can be significantly decreased Conclusion: Reflexology is an appropriate pain relief and prophylaxis for any kind of pain, especially delivery and post-delivery pain. It is a safe remedy with no adverse effects reported so far.
... It has psychological benefits such as relaxation. Additionally, it had been reported that the reflexology effects valuably on the baroreceptors reflex sensitivity, sinus arrhythmia (Lu, et al., 2011) and impact positively on the physiological parameters i.e. SBP, DBP and heart rate (HR) (Moeini, et al., 2011). ...
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Objective: Hot flashes, a symptom of menopause, can decrease women's quality of life. Sympathetic nervous system activation has been identified as an important factor in the occurrence of hot flashes. Given that somatosensory stimulation of the oral cavity can affect autonomic nervous activity, we aimed to investigate the possibility that somatosensory stimulation of the gums (i.e., gum massage) could improve hot flashes. Materials and methods: Nineteen women experiencing at least one hot flash per day were instructed to perform a gum massage on themselves before undertaking mental workload, using arithmetic task, and the frequency of hot flashes experienced during this task was measured. Changes in autonomic nervous activity were assessed based on heart rate variability. Results: Massage conditions promoted a significantly lower arithmetic task-induced hot flash frequency compared with nonmassage conditions (p < 0.05). During gum massage, the ratio between low and high frequency (LF/HF) values decreased significantly under massage conditions compared with nonmassage conditions (p < 0.01). During the arithmetic task, the gum massage-induced reduction in LF/HF, which changed from baseline, was significantly correlated with the gum massage-induced reduction in hot flash frequency. Conclusions: The results of this study indicate that gum massage can reduce the subjective frequency of hot flashes over a certain period under mental workload. Our study also indicates that gum massage can potentially decrease sympathetic nerve activity, which is known to be involved in the occurrence of hot flashes. Clinical Trial Registration number 328 (the institutional review board of Lion Corporation).
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Aims This study used pretest-posttest randomized group comparison to investigate the acute effects of foot reflexology massage (FRM) intervention on the pulse harmonic and parasympathetic modulation after repeated sprint ability test (RSA) and Yo Yo intermittent recovery test level 1 (YOYO). Background The arterial pulse wave characteristics (APW) is a physiological indicator of peripheral arterial compliance. Reflexology massage is a non-invasive intervention to improve arterial compliance. However, the acute effect of FRM on APW after intense exercise has not been examined. Objective The purpose of this study was to investigate the acute effect of FRM after short-term bouts of anaerobic-based and aerobic-based intermittent exercises. Methods Twenty-six collegiate male football/futsal players voluntarily participated in this study. All participants were randomly assigned to FRM group ( n = 14) or control group ( n = 12). The participants performed RSA and YOYO exercise protocols at least 3 days apart within a week. The electrocardiography (ECG), and APW of right hand (RH), left hand (LH), and left foot (LF) were recorded for 10 min in supine position before and after interventional/control period. A standard of 30 min FRM was given immediately after exercises, whereas those of control group were requested to rest comfortably on a massage table for 30 min. Non-parametric statistical analyses (The Mann-Whitney rank and Wilcoxon signed rank test) were used to compare the measured variables. Results The results showed different characteristics of sympathetic nervous system index after RSA and YOYO protocols in the FRM and control groups [FRM: RSA ( p = 0.01); Control: YOYO ( p < 0.01)]. The results also identified similar exercise-induced modulation of 1 st and 2 nd pulse harmonics in LF location with or without FRM treatment. Conclusion The FRM intervention demonstrated minor impact on the recovery of APW and parasympathetic modulation after RSA and YOYO exercises. Clinical Trail Registration Number : NCT03821805
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Background and purpose The aim of this study was to determine the effect of foot reflexology on chest pain and anxiety in patients with AMI. Materials and methods This study was a double blind randomized clinical trial. Stratified random sampling was carried out on 90 patients with AMI in the three groups of treatment, placebo and control. Foot reflexology was done for three consecutive days, each time for 20 minutes. Chest pain and anxiety were evaluated with Visual Analogue Scale before, immediately and 20 minutes later. Results 20 minutes after the intervention, severity of chest pain in treatment group was significantly lower than control group (p<0.001) and placebo group (p=0.002). Severity of anxiety between groups and at different times was not significant. Conclusions Foot reflexology was effective in attenuating chest pain, had the most effect in 20 minutes after intervention, and can be used to relieve chest pain in patients with AMI.
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Purpose: This study aimed to evaluate the effect of reflexology on fatigue, pain, and sleep quality in lymphoma patients. Method: This study was a randomized clinical trial with pre-post design. Seventy-two lymphoma patients admitted in hematology wards affiliated to Shiraz University of Medical Sciences, Shiraz, Iran in 2018 were randomly assigned to intervention and control groups. Patients in the intervention group underwent foot reflexology for five consecutive days. The control group received usual care. The data were collected by the Multidimensional Fatigue Inventory, a numerical pain scale, and Pittsburgh Sleep Quality index. Data analysis was done by the SPSS software, version 21 using ANCOVA, paired t-test, and Wilcoxon test. Results: At baseline, both intervention and control groups were the same in terms of fatigue, pain, and sleep quality (p > 0.05). However, a significant difference was found between the two groups regarding fatigue, pain, and sleep quality after the intervention (all p < 0.05). Conclusion: The results showed that reflexology could reduce fatigue and pain and improve the quality of sleep in patients with lymphoma. Considering the effectiveness of reflexology in lymphoma patients, healthcare workers including nurses are recommended to use this complementary therapy to reduce fatigue and pain and improve sleep quality in lymphoma patients.
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In 57 normal subjects (age 20-60 years), we analyzed the spontaneous beat-to-beat oscillation in R-R interval during control recumbent position, 90° upright tilt, controlled respiration (n = 16) and acute (n = 10) and chronic (n = 12) β-adrenergic receptor blockade. Automatic computer analysis provided the autoregressive power spectral density, as well as the number and relative power of the individual components. The power spectral density of R-R interval variability contained two major components in power, a high frequency at ~ 0.25 Hz and a low frequency at ~ 0.1 Hz, with a normalized low frequency: high frequency ratio of 3.6 ± 0.7. With tilt, the low-frequency component became largely predominant (90 ± 1%) with a low frequency: high frequency ratio of 21 ± 4. Acute β-adrenergic receptor blockade (0.2 mg/kg IV propranolol) increased variance at rest and markedly blunted the increase in low frequency and low frequency: high frequency ratio induced by tilt. Chronic β-adrenergic receptor blockade (0.6 mg/kg p.o. propranolol, t.i.d.), in addition, reduced low frequency and increased high frequency at rest, while limiting the low frequency: high frequency ratio increase produced by tilt. Controlled respiration produced at rest a marked increase in the high-frequency component, with a reduction of the low-frequency component and of the low frequency: high frequency ratio (0.7 ± 0.1); during tilt, the increase in the low frequency: high frequency ratio (8.3 ± 1.6) was significantly smaller. In seven additional subjects in whom direct high-fidelity arterial pressure was recorded, simultaneous R-R interval and arterial pressure variabilities were examined at rest and during tilt. Also, the power spectral density of arterial pressure variability contained two major components, with a relative low frequency: high frequency ratio at rest of 2.8 ± 0.7, which became 17 ± 5 with tilt. These power spectral density components were numerically similar to those observed in R-R variability. Thus, invasive and noninvasive studies provided similar results. More direct information on the role of cardiac sympathetic nerves on R-R and arterial pressure variabilities was derived from a group of experiments in conscious dogs before and after bilateral stellectomy. Under control conditions, high frequency was predominant and low frequency was very small or absent, owing to a predominant vagal tone. During a 9% decrease in arterial pressure obtained with IV nitroglycerin, there was a marked increase in low frequency, as a result of reflex sympathetic activation. Bilateral stellectomy prevented this low-frequency increase in R-R but not in arterial pressure autospectra, indicating that sympathetic nerves to the heart are instrumental in the genesis of low-frequency oscillations in R-R interval.
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Using colour Doppler sonography blood flow changes of the right kidney during foot reflexology were determined in a placebo-controlled, double-blind, randomised study. 32 healthy young adults (17 women, 15 men) were randomly assigned to the verum or placebo group. The verum group received foot reflexology at zones corresponding to the right kidney, the placebo group was treated on other foot zones. Before, during and after foot reflexology the blood flow of three vessels of the right kidney was measured using colour Doppler sonography. Systolic peak velocity and end diastolic peak velocity were measured in cm/s, and the resistive index, a parameter of the vascular resistance, was calculated. The resistive index in the verum group showed a highly significant decrease (p ≤ 0.001) during and an increase (p = 0.001) after foot reflexology. There was no difference between men and women and no difference between smokers and non-smokers. Verum and placebo group significantly differed concerning alterations of the resistive index both between the measuring points before versus during foot reflexology (p = 0.002) and those during versus after foot reflexology (p = 0.031). The significant decrease of the resistive index during foot reflexology in the verum group indicates a decrease of flow resistance in renal vessels and an increase of renal blood flow. These findings support the hypothesis that organ-associated foot reflexology is effective in changing renal blood flow during therapy.
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The objective of this pilot study is to identify if reflexology and foot massage (FM) affect the physiology of the body by measuring baroreceptor reflex sensitivity (BRS) using phase IV of the Valsalva manoeuvre, blood pressure (BP) and sinus arrhythmia (SA). The reflexology (n = 10) and FM groups (n = 10) showed significantly greater reductions in BRS compared to the control group (n = 4). Analysis of the mean differences between groups showed a greater difference in BRS between reflexology or FM and the control group than between reflexology and FM. This study found no significant difference in resting BP after intervention. The frequency of SA after reflexology and FM increased by 43.9% and 34.1% respectively. Further thoughts from the results of this study suggest a ‘neuro theory’ whereby reflexology and FM alter the BRS by stimulating the sensory nervous system in the feet.
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Over the past three decades the changes in sympathoadrenal function that occur with age in healthy adult humans have been systematically studied using a combination of neurochemical, neurophysiological and haemodynamic experimental approaches. The available experimental evidence indicates that tonic whole-body sympathetic nervous system (SNS) activity increases with age. The elevations in SNS activity appear to be region specific, targeting skeletal muscle and the gut, but not obviously the kidney. The SNS tone of the heart is increased, although this appears to be due in part to reduced neuronal reuptake of noradrenaline (norepinephrine). In contrast to SNS activity, tonic adrenaline (epinephrine) secretion from the adrenal medulla is markedly reduced with age. This is not reflected in plasma adrenaline concentrations because of reduced plasma clearance. Despite widely held beliefs to the contrary, sympathoadrenal responsiveness to acute stress is not exaggerated with age in healthy adults. Indeed, adrenaline release in response to acute stress is substantially attenuated in older men. The mechanisms underlying the age-associated increases in SNS activity have not been established, but our preliminary data are consistent with increased subcortical central nervous system (CNS) sympathetic drive. These changes in sympathoadrenal function with advancing age may have a number of important physiological and pathophysiological consequences for human health and disease.
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Objectives: This study compares 24-h parasympathetic activity in aerobically trained and untrained healthy young men. Background: Higher values of parasympathetic nervous system activity are associated with a low mortality rate in patients after myocardial infarction, but it remains uncertain what therapeutic interventions can be used to increase parasympathetic activity. Although it is thought that exercise training can increase parasympathetic activity, studies have reported conflicting results, perhaps because this variable was measured for only brief intervals and usually inferred from changes in reflex responses induced by pharmacologic blockade. Methods: Parasympathetic activity was assessed noninvasively from 24-h ECG recordings by calculating high frequency (0.15 to 0.40 Hz) beat to beat heart period variability in eight endurance-trained men (maximal oxygen consumption greater than or equal to 55 ml/kg per min) and eight age-matched (mean = 29 yr) untrained men (maximal oxygen consumption less than or equal to 40 ml/kg per min). The data were analyzed separately for sleeping hours when parasympathetic activity is dominant and also for waking hours. Results: The geometric mean of high frequency power was greater in the trained than in the untrained men during the day (852 vs. 177 ms2, p less than 0.005), during the night (1,874 vs. 427 ms2, p less than 0.005) and over the entire 24 h (1,165 vs. 276 ms2, p less than 0.001). Conclusions: Parasympathetic activity is substantially greater in trained than in untrained men, and this effect is present during both waking and sleeping hours. These data suggest that exercise training may increase parasympathetic activity over the entire day and may therefore prove to be a useful adjunct or alternative to drug therapy in lessening the derangements of autonomic balance found in many cardiovascular diseases.
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Early detection and a quantitative evaluation of the degree of diabetic autonomic neuropathy were performed in 23 diabetic patients and 22 controls by computerized spectral analysis of beat-to-beat R-R interval variations on a continuous electrocardiogram. Simultaneous recording of cardiac and respiratory activity, R-wave detection by a fast peak detection algorithm and spectrum computation by Fast Fourier transform enabled the study of the power spectrum of heart rate fluctuations. The power of fluctuations at different frequencies is the result of sympathetic and vagal input into the sinoatrial node: this input is derived from vasomotor, baroreceptor and respiratory control loops. A marked reduction in the power of heart rate (HR) fluctuations, at all frequencies, was found in the diabetic patients as compared to controls. This indicates a depression of both parasympathetic and sympathetic activity. The difference was especially pronounced in subjects below age 65. The lowest activity was found in diabetics with concomitant peripheral neuropathy. The method described here is simple, objective, quantitative and very sensitive. It may facilitate the screening of diabetic patients for autonomic neuropathy and enable a convenient quantitative follow-up.
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Background: It is unclear from prior reports whether the relationships between self-ratings of anxiety or emotional stress and parasympathetic nervous system components of heart rate variability are independent of personality and cardiorespiratory fitness. We examined those relationships in a clinical setting prior to a standardized exercise test. Methods and results: Heart rate variability (HRV) was measured during 5 min of supine rest among 92 healthy men (N=52) and women (N=40) who had above-average cardiorespiratory fitness as indicated by peak oxygen uptake measured during grade-incremented treadmill exercise. HRV datasets were decomposed into low-frequency (LF; 0.05-0.15 Hz) and high-frequency (HF; 0.15-0.5 Hz) components using spectral analysis. Self-ratings of trait anxiety and perceived emotional stress during the past week were also assessed. Conclusions: There was an inverse relationship between perceived emotional stress during the past week and the normalized HF component of HRV (P=0.038). This indicates a lower cardiac vagal component of HRV among men and women who perceived more stress. That relationship was independent of age, gender, trait anxiety, and cardiorespiratory fitness. It was also independent of heart rate; mean arterial blood pressure; and respiration rate, factors which can influence HRV and might be elevated among people reporting anxiety and perceived stress. We conclude that vagal modulation of heart period appears to be sensitive to the recent experience of persistent emotional stress, regardless of a person's level of physical fitness and disposition toward experiencing anxiety.