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Cardiovascular effects of reflexology in healthy individuals: evidence for a specific increase in blood pressure

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The present study evaluates the cardiovascu-lar effects of reflexology in a healthy sample. Forty-one participants were randomly assigned to one of three experimental groups: reflexolo-gy (n=15), non-professional foot massage (n=14), and a waiting time control group (n=12). Dependent variables were systolic, diastolic and mean blood pressure, inter-beat interval, heart rate variability and baroreceptor reflex sensitivity measured pre-and post-inter-ventions. The study was performed during three 40-min sessions separated by weekly intervals. Results show that the three manipu-lations produce similar increases in inter-beat interval, heart rate variability and baroreceptor reflex sensitivity. Reflexology specifically pro-duces an increase in blood pressure, which increases gradually over the three sessions. The parallel increase in heart rate variability and baroreceptor reflex sensitivity together with the increase in blood pressure suggest that reflexology is associated with a co-activa-tion of both sympathetic and parasympathetic branches of the Autonomic Nervous System. These changes could be helpful in optimizing homeostatic activity, promoting the healing process and increasing the human organism's capacity to respond adaptively to internal and external challenges. Finally, the observed phys-iological changes in the waiting-time control group shows the relevance of habituation processes and suggests the need for addition of waiting-time control groups in future studies.
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[page 10] [Alternative Medicine Studies 2012; 2:e4]
Cardiovascular effects
of reflexology in healthy
individuals: evidence
for a specific increase
in blood pressure
Elisabeth Ruiz-Padial,
Nieves Torres López,
Javier Luna Bujaldón,
Isabel Espadas Villanueva,
Gustavo A. Reyes del Paso
University of Jaén, Jaén, Spain.
Abstract
The present study evaluates the cardiovascu-
lar effects of reflexology in a healthy sample.
Forty-one participants were randomly assigned
to one of three experimental groups: reflexolo-
gy (n=15), non-professional foot massage
(n=14), and a waiting time control group
(n=12). Dependent variables were systolic,
diastolic and mean blood pressure, inter-beat
interval, heart rate variability and baroreceptor
reflex sensitivity measured pre- and post- inter-
ventions. The study was performed during
three 40-min sessions separated by weekly
intervals. Results show that the three manipu-
lations produce similar increases in inter-beat
interval, heart rate variability and baroreceptor
reflex sensitivity. Reflexology specifically pro-
duces an increase in blood pressure, which
increases gradually over the three sessions.
The parallel increase in heart rate variability
and baroreceptor reflex sensitivity together
with the increase in blood pressure suggest
that reflexology is associated with a co-activa-
tion of both sympathetic and parasympathetic
branches of the Autonomic Nervous System.
These changes could be helpful in optimizing
homeostatic activity, promoting the healing
process and increasing the human organism’s
capacity to respond adaptively to internal and
external challenges. Finally, the observed phys-
iological changes in the waiting-time control
group shows the relevance of habituation
processes and suggests the need for addition of
waiting-time control groups in future studies.
Introduction
Reflexology is a form of healing already
practiced more than 4000 years ago in Ancient
China and Egypt.1Its basic premise is that all
glands, organs and systems of the body are rep-
resented on the feet, in such a way that by
pressing reflex points on the feet it is possible
to produce specific effects in those glands,
organs or systems. It is therefore assumed that
reflexology helps to maintain overall health
and relieve symptoms of stress and disease.1
This technique has been used for centuries
and reflexologists claim its effectiveness in
alleviating a wide range of diseases and afflic-
tions, such as pre-menstrual symptoms,2lower
back pain,3diabetes,4cancer,5multiple sclero-
sis,6anxiety,7asthma,8etc. However, the
methodological quality of most randomized
controlled studies is poor and the few well-con-
trolled studies show inconclusive results.9
There is recent evidence from a neuroimag-
ing study supporting the basic assumption
underlying foot reflexology. Nakamaru and col-
leagues10 found that reflexological stimulation
of foot reflex areas activated the somatosenso-
ry cortical areas of the corresponding body
parts. This finding is relevant since it demon-
strates that at least some parts of the body may
have reflex points in the foot. However, some
important aspects remain unclear. Does the
reflexology affect the functioning of the organs
that are stimulated? How exactly does reflexol-
ogy affect the healing process? It has been pro-
posed that reflexology stimulates the circulato-
ry and lymphatic systems, parasympathetic
activity, restorative sleep, etc,. while other
more secondary mechanisms such as relax-
ation, placebo effect, the therapeutic interac-
tion or the well known benefits of skin-to-skin
contact have been also considered.1,11,13
The skin-to-skin contact factor could be an
important mediating mechanism in the thera-
peutic effects of massage therapies in general.
Interpersonal touch has been shown to be
related to health and numerous studies have
related physical contact to decreases in blood
pressure and heart rate.14,15 Skin contact is
one of the primary mechanisms for the release
of oxytocin, a neuropeptide hormone with an
important protective effect on the autonomic
and cardiovascular systems. Oxytocin secre-
tion inhibits alpha-adrenergic and hypothala-
mic pituitary-adrenal activity, reduces cate-
cholamine, blood pressure and cardiac output
levels, and enhances vagal activity.14,16-19 It is
essential to distinguish between the simple
effects of skin-to-skin contact and the specific
effects of reflexology in order to be able to con-
firm the efficacy of reflexology.
For two main reasons it is particularly
important to focus on the effect that reflexolo-
gy may have on cardiovascular variables. On
the one hand, one of the major explanations
for the underlying mechanisms of reflexology
is its effect on the circulatory system,12 so it
could be expected to find changes in cardiovas-
cular parameters after reflexology. On the
other hand, some cardiovascular measures,
such as heart rate variability and baroreceptor
reflex sensitivity, have been demonstrated to
be good indices of the organism’s auto-regula-
tory capacity and health.20-25
Non-invasive evaluation of autonomic
integrity and functioning can be performed by
means of heart rate variability, a measure of reg-
ular fluctuations in heart rate over time.26 The
baroreceptor reflex constitutes another impor-
tant source of autonomic regulation. The arteri-
al baroreceptors are stretch receptors located in
the wall of the carotid sinus and the aortic arch
and as such are a basic mechanism for the reg-
ulation of blood pressure. Increases in blood
pressure stretch the walls, stimulating the
baroreceptors, which in turn set off a reaction
through the brainstem centers producing a
reduction in heart rate, the contractility of the
heart, and vascular tone, leading in turn to a
reduction in blood pressure. The opposite occurs
when blood pressure decreases. In this way, the
activity of the baroreflex prevents rapid swings
in blood pressure by eliciting compensatory
adjustments in both parasympathetic and sym-
pathetic activation.27 The cardiac branch of the
reflex that relates blood pressure to inter-beat
interval is a powerful source of vagal afferent
input to the central nervous system. Moreover it
Alternative Medicine Studies 2012; volume 2:e4
Correspondence: Elisabeth Ruiz-Padial,
Universidad de Jaén, Campus Las Lagunillas,
Edif. C-5, 23071 Jaén, Spain.
Tel. +34.953.213.451 - Fax: +34.953.211.881.
E-mail: erpadial@ujaen.es
Key words: reflexology, foot massage, inter-beat
interval, heart rate variability, baroreceptor reflex
sensitivity.
Acknowledgments: this research was supported
by a grant from the Junta de Andalucía (Research
Group: HUM338).
Contributions: ERP, design and analysis of the
physiological data, review of the literature, writ-
ing of the manuscript; NTL, conception of the
study, interpretation of the results; JLB, concep-
tion, design and drafting of the paper, processing
of the self-report measures and the statistical
analysis. IEV, conception and design of the study,
drafting and the review of the article; GARPaso,
design of the study, analysis and interpretation of
the physiological results, writing of the paper.
Conflict of interest: the authors report no con-
flicts of interest.
Received for publication: 23 September 2011.
Revision received: 30 December 2011.
Accepted for publication: 19 January 2012.
This work is licensed under a Creative Commons
Attribution NonCommercial 3.0 License (CC BY-
NC 3.0).
©Copyright E. Ruiz-Padial et al., 2012
Licensee PAGEPress, Italy
Alternative Medicine Studies 2012; 2:e4
doi:10.4081/ams.2012.e4
Non-commercial use only
[Alternative Medicine Studies 2012; 2:e4] [page 11]
is one of the most important physiological mech-
anisms affecting efferent cardiac vagal activity
and the main generator of autonomic parasym-
pathetic measures such as respiratory sinus
arrhythmia and heart rate variability.27-29 It is
well established that autonomic parasympathet-
ic control is strongly associated with cardiovas-
cular diseases and is a powerful prognostic indi-
cator of cardiovascular health.23,24
The arterial baroreceptors, furthermore,
constitute the starting point of an afferent
pathway by which cardiovascular function
modulates central nervous activity.
Responding to mechanical stretch of the
carotid and aortic vessel walls, the barorecep-
tors trigger a global inhibitory effect on brain
activity that decreases somatic muscle tone,
stimulates sleep, inhibits spinal somatic sen-
sory pathways, reduces anger, anxiety and pain
and attenuates behavioural reactions to
painful and aversive stimuli.30-32 The barore-
flex’s inhibitory modulation of cerebral struc-
tures related to emotion and arousal is the
foundation for techniques for strengthening
the baroreceptors such as those that have tra-
ditionally been used in Russia for the treat-
ment of psychosomatic disorders such as asth-
ma, arterial hypertension, insomnia, etc.33,34
For all these reasons, heart rate variability and
baroreceptor functioning are good candidates
for the evaluation of the efficacy of reflexology.
To the best of our knowledge, few studies
have explored the effects of reflexology on car-
diac variables and most of them present impor-
tant methodological weakness. Frankel35 found
that reflexology and foot massage reduced
baroreceptor reflex sensitivity. However, this
result must be considered cautiously. In addi-
tion to using a small sample, the technique
used (the valsalva manoeuvre) is a now obso-
lete invasive method.36 Furthermore, some
contradictory associations found in this study
such as the negative relation between barore-
ceptor reflex sensitivity and respiratory sinus
arrhythmia are contrary to current evi-
dence,28,37 therefore suggesting the need for
new studies evaluating the effects of reflexolo-
gy on baroreceptor functioning using more up-
to-date methodology.
Some studies have evaluated the effects of
reflexology on heart rate variability. Joseph et
al.38 and Zhen et al.39 found decreases in heart
rate variability during reflexology in comparison
to a relaxed sitting position. This result seems
contra-intuitive and is contrary to findings from
other types of massage techniques such as the
myofascial trigger-point massage, which has
been shown to increase heart rate variability.40
Other studies have found a reduction in sys-
tolic blood pressure and heart rate following
reflexology7and other methods such as deep-
tissue massage therapy.41 Furthermore,
Ejindu42 found that while facial massage pro-
duces a reliable decrease in blood pressure, the
effects of foot massage on blood pressure are
negligible. Studies using electrical massage
devices, which perform pulse-synchronized
massage with air cuffs, have found that mas-
sage pulses increase peripheral vascular blood
flow, an effect that can influence venous return
and subsequent autonomic nerve activity.43
In addition to using small samples, many of
these studies do not include appropriate mas-
sage control groups, making it difficult to con-
clude whether the effects observed are due to
the reflexology or to the skin-to-skin contact.
More importantly, the studies aiming to evalu-
ate the effects of reflexology on physiological
parameters usually utilize a pre- post-interven-
tion assessment. None of these studies has
controlled for the effect of habituation to the
setting in which the intervention is performed.
Habituation is a non-associative learning
process that implicates a decrease in physio-
logical indices as the subject gets used to the
situation. The environmental context used in
these intervention studies is new for the sub-
ject (devices, wires, interpersonal contact,
etc.) and therefore has arousing properties.
Thus any decrease in physiological indices
might also be due to this habituation process.
The aim of the present study was to evaluate
the cardiovascular effects of reflexology in
comparison with a foot-massage procedure (to
control for the skin-to-skin contact factor) and
a waiting-time control group (to control for the
habituation process) in healthy participants.
Dependent variables were blood pressure,
inter-beat interval, heart rate variability and
baroreceptor reflex sensitivity. Furthermore,
the effects of the three procedures on self-
reported anxiety were assessed.
Materials and Methods
Subjects
Forty-one psychology students (20 male and
21 female) from the University of Jaén voluntar-
ily participated in the study. Their mean age
was 20.85±2.96 years and all of them were
healthy (none presented a diagnosis, history or
symptoms of any disease). Our students were
informed in classroom that they could sign in a
list if they were interested in participating in a
study on the effects of different techniques of
alternative medicine on psychophysiological
responses. Participants were randomly
assigned to one of three experimental groups:
15 to the reflexology group (R), 14 to the non-
professional foot massage (M) and 12 to the
waiting time control group (C). They did not
know the specific goals of the study nor which
group they were assigned to. The study protocol
was approved by the Bioethics Committee of the
University of Jaén and all the participants
signed the informed consent form.
Apparatus
Blood pressure was recorded continuously
and non-invasively on a beat-to-beat basis with
the Ohmeda 2300 BP monitor (Ohmeda,
Louisville, KY) from the middle phalanx of the
third finger of the right hand. The hand was
positioned at the level of the heart. This device
measures blood pressure following the vascu-
lar wall unloading principle and has been vali-
dated against intra-arterial continuous record-
ing.44 Electrocardiogram (ECG) was obtained
from Einthoven Lead II using a Biopac ECG
amplifier. Data acquisition and recording of
both ECG and blood pressure were carried out
at 500 Hz using a Biopac MP100 system
(Biopac System Inc., Goleta, CA).
Experimental group manipulations
For the reflexology group, the Ingham
method of reflexology was used, carried out by
one of the authors, an expert reflexologist.
Each session lasted 40 min (20 min each foot)
and started with the warming of one foot fol-
lowed by pressing the reflex point called solar
plexus seven times according to the respira-
tion of the participant, after which the reflexo-
logical massage covered urinary, circulatory,
immune, endocrine and central nervous sys-
tems as well as the spinal column, ending with
relaxation, after which the same sequence was
repeated for the other foot. Since skin-to-skin
contact may be one of the mediation mecha-
nisms in the efficacy of reflexology, another
group of participants received a non-profes-
sional foot massage lasting 20 min for each
foot. This massage was carried out by a stu-
dent who had no previous experience as a
masseur or reflexologist. To discard the effects
of habituation to the laboratory environment
on the dependent variables, a waiting time
control group was used. They received no treat-
ment and were seated for 40 min in a darkened
room under the same conditions as the other
two groups.
Self-reported variables
Anxiety was assessed with the Spanish
adaptation of the State-Trait Anxiety Inventory
(STAI).45 We also developed two scales to eval-
uate the pleasantness and pain associated
with the two massage procedures. Participants
were asked to rate the pleasantness and
painfulness of both massage procedures using
a 0 to 10 scale (0 meaning not at all and 10
extremely pleasant and painful, respectively).
Procedure
Each participant attended three sessions sep-
arated by weekly intervals. All the sessions were
conducted in the Psychophysiology laboratory,
in a temperature-controlled room (mean tem-
perature was 23.6°C). Prior to the first session,
an interview was conducted in order to evaluate
Article
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[page 12] [Alternative Medicine Studies 2012; 2:e4]
health status and pharmacological or psychi-
atric treatment. After receiving instructions, the
participant signed an informed consent form, as
we described above, and answered some ques-
tions related to age, exercise, menstrual cycle
(women only), any type of medications, alcohol
and food or drink consumed before the session.
After this, each participant completed the two
scales of the STAI (A/R –trait- and A/E –state).
Then electrodes were placed on the participant
and he/she was asked to seat comfortably in a
reclined position. After a 10-min rest period, a
5-min resting baseline of BP and ECG recording
was made after which the participant either
received a 20-min massage on each foot
(groups R and M) or was left alone for 40 min-
utes (group C). Immediately afterwards, a fur-
ther 5-min recording was taken. Finally, all par-
ticipants were given the State form of the STAI
and the R and M groups also completed the
scales for pleasantness and painfulness associ-
ated with the massage. With the exception of
the initial interview, the instructions and sign-
ing of the informed consent form, the second
and third sessions were identical to the first
one. Participants were instructed to refrain
from drinking caffeine or alcohol or performing
vigorous exercise for 2 h prior to the sessions.
Data reduction and analysis
Blood pressure was analyzed by obtaining
the systolic, diastolic and mean values for each
beat. Inter-beat interval was obtained from the
interval between successive ECG R-R waves.
Baroreceptor function was evaluated with a
time-domain program46 which locates either i)
sequences of three to six consecutive cardiac
cycles in which systolic blood pressure increas-
es (of at least 1 mmHg to each beat) in combi-
nation with an increase in inter-beat interval
(of at least 2 ms in each beat) or ii) sequences
in which the decrease of systolic blood pressure
is accompanied by a decrease in inter-beat
interval (following the same criteria of mini-
mum change). Each systolic value is paired
with the inter-beat interval calculated from the
very next heart beat -a lag of one beat- which is
associated with better estimates of barorecep-
tor reflex sensitivity.47 When one of these
sequences is detected, the corresponding
regression line is computed across all pulses in
that particular sequence. Baroreceptor reflex
sensitivity is expressed as the change in inter-
beat interval (in ms) per mmHg change in sys-
tolic blood pressure and is measured by the
slope of the regression line. Heart rate variabil-
ity was measured in the time-domain with the
root mean square successive difference
(RMSSD) of the inter-beat interval time-series.
There is a strong association between RMSSD
and respiratory sinus arrhythmia and parasym-
pathetic outflow.48,49 Finally, as an index of
blood pressure variability, the RMSSD of sys-
tolic blood pressure was also obtained.
Homogeneity of variances and normality
assumptions were assessed with the Levene
and Kolmogorov-Smirnov tests, respectively.
All variables analyzed fulfills the requirements
of parametric statistical analysis. We detect
baseline group differences for inter-beat inter-
val (F(2, 40)=6.38, P=0.004) and mean blood
pressure (F(2, 40)=3.643, P=0.036), as well as
trends for systolic blood pressure (F(2,
40)=1.94, P=0.157) and diastolic blood pres-
sure (F(2, 40)=2.38, P=0.106). In order to con-
trol such group differences, statistical analyses
for the above parameters were performed with
a 3(¥3¥2) repeated measures ANCOVA the
first factor between-group (Condition, manip-
ulated at three levels: reflexology, foot massage
and control), and two repeated-measures fac-
tors: session, with three levels (session 1, 2
and 3) and time, with two levels (pre- and post-
intervention or beginning and end of the ses-
sion for the waiting time control group).The
baseline value during the first session was
introduced as covariable. The remaining
parameters (systolic blood pressure variability,
inter-beat interval variability, baroreceptor
reflex sensitivity and the self-reported meas-
ures) were analyzed with a 3(¥3¥2) repeated
measures MANOVA, Effect sizes were calculat-
ed with the η² parameter. Post-hoc compar-
isons were performed with the Bonferroni pro-
cedure to control for the number of compar-
isons performed.
Results
Physiological measures
Blood pressure
Average values of systolic, diastolic and
mean blood pressure through the course of the
study are displayed in Figures 1 - 3. For systolic
blood pressure the ANCOVA shows significant
effects in the time (F(1,37)=11.91, P=0.001,
η2=0.243), condition (F(2,37)=7.85, P=0.001.
η2=0.298) and sessions (F(2,36)=4.59,
P=0.017, η2=0.203) factors. The interactions
time x condition (F(2,37)=10.29, P<0.0001,
η2=0.3585) and time¥sessions (F(2,36)=4.55,
P=0.017, η2=0.201) were also significant.
The analysis of the interaction
Time¥Condition shows that in the reflexology
group the Time factor was significant
(F(1,14)=33.90, P<0.0001, η2=0.708). As can
be observed in Figure 1, the reflexology inter-
vention increases blood pressure in that group.
In the foot massage group, the Time factor is
significant as a function of Sessions
(F(2,12)=9.11, P<0.01, η2=0.602). In this
group the Pre-Post comparison was significant
only in the second session (F(1,13)=5.20,
P<0.05, η2=0.284) where foot massage
increases blood pressure. In the control group
the Time factor was not significant. As shown
by the significant main Condition factor effect,
the increase in blood pressure after reflexolo-
gy results in greater levels of blood pressure in
the reflexology group than in the foot massage
group (P<0.0001) and the control group
(P<0.05), while the latter two groups did not
differ from one another (P=0.292). Table 1 dis-
plays the complete post-hoc analysis for sys-
tolic blood pressure. As can be observed, the
reflexology group shows higher blood pressure
values than the other two groups in the Post
periods of the three sessions, while the foot
massage and control groups did not show any
difference.
The effect of the Session factor is explained
by a decrease in blood pressure in the course of
the sessions that is especially larger in the
baseline periods and in the comparison
between the first and the second sessions
Article
Figure 1. Systolic blood pressure during the three sessions as a function of conditions.
Bars indicate standard errors of the mean.
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[Alternative Medicine Studies 2012; 2:e4] [page 13]
(t=4.84, P<0.0001). The interaction Time¥
Sessions is explained by the Time factor, which
was significant in the second (F(1,38)=27.26,
P<0.0001, η2=.418) and third (F(1,38)=15.04,
P<0.0001, η2=0.284) sessions, but not in the
first one.
The results of the ANCOVA for diastolic and
mean blood pressure are displayed in Table 2.
As can be observed, the effects are similar to
those found for systolic blood pressure.
As regards systolic blood pressure variabili-
ty, the MANOVA show significant effects in the
Time factor (F(1,38)=8.89, P<0.005, η2=0.19).
As can be observed in Figure 4, systolic blood
pressure variability increases after the inter-
vention, especially for the reflexology and foot
massage groups, but the interaction
Time¥Condition does not reach significance.
Inter-beat interval
The Time factor was significant
(F(1,37)=57.45, P<0.001, η2=0.456) as was
the interaction Time¥Sessions (F(2,36)=4.23,
P<0.05, η2=0.187). As can be observed in
Figure 5, inter-beat interval increases in all
three groups in the post-period. Although this
effect is observed in the three sessions, its sta-
tistical significance is reduced as a function of
sessions (F(1,38)=63.56, P<0.0001, η2=0.624;
F(1,38)=27.6, P<0.0001, η2=0.421; F(1,38)=
14.5, P<0.0001, η2=0.277; respectively for ses-
sions 1, 2, and 3).
As regards heart rate variability, the Time
factor was also significant (F(1,38)=30.21,
P<0.0001, η2=0.443) as was the interaction
Time¥Sessions (F(2,37)=3.326, P<0.05, η2=
0.152). As can be observed in Figure 6, heart
rate variability increases in the three groups
after intervention and again this effect decreas-
es as a function of sessions (F(1,38)=27,
P<0.0001, η2=0.417; F(1,38)=11.00, P<0.01,
η2=0.225; F(1,38)=9.14, P<0.01, η2=0.194;
respectively for sessions 1, 2, and 3).
Baroreceptor reflex sensitivity
The only significant effect found was for the
Time factor (F(1,38)=19.27, P<0.0001, η2=
0.337). As can be observed in Figure 7, barore-
ceptor reflex sensitivity increases in the three
groups after intervention.
Self-report measures
Anxiety
A main effect of Time (F(1,38)=40.89,
P<0.0001, η2=0.518) and a significant interac-
tion Time¥Condition (F(2,38)=6.37, P<0.004,
η2=0.251) were observed. As displayed in
Figure 8, anxiety decreases after reflexology
(F(1,14)=19.27, P<0.001, η2=0.579) and foot
massage (F(1,13)=26.52, P<0.0001, η2=0.671)
but does not change in the waiting control
group.
Article
Figure 2. Diastolic blood pressure during the three sessions as a function of conditions.
Bars indicate standard errors of the mean.
Figure 3. Mean blood pressure during the three sessions as a function of conditions. Bars
indicate standard errors of the mean.
Figure 4. Systolic blood pressure variability during the three sessions as a function of con-
ditions. Bars indicate standard errors of the mean.
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[page 14] [Alternative Medicine Studies 2012; 2:e4]
Pleasantness and pain in the two
massage procedures
Both reflexology and non-professional foot
massage were evaluated as equally pleasant
(8.46±1.2 for the R group and 8.98±1.04 for the
M group). None of the main factors or their
interaction were significant. As regards inten-
sity of the pain, results showed significant
effects of Condition (F(1,27)=20.49, P<0.0001,
η2=0.431), Session (F(2,26)=5.174, P<0.05,
η2=0.285) and the interaction Condition¥
Session (F(2,26)=4.04, P<0.05, η2=0.237). As
can be observed in Figure 9, the reflexology
group rated the massage as more painful,
especially during the first session (F(2,13)
=5.47, P<0.05, η2=0.457).
Discussion
Our results indicate that reflexology pro-
duces an increase in blood pressure within
session (systolic, diastolic and mean blood
pressure) in comparison with the foot mas-
sage and the waiting-control group. No differ-
ences were found between the three condi-
tions regarding the other physiological meas-
ures. Inter-beat interval, heart rate variability
and baroreceptor reflex sensitivity increase
after reflexology, foot massage and waiting
time. However, the increase in inter-beat inter-
val and heart rate variability after the three
procedures decreases over the course of the
sessions, showing a habituation process. It is
noticeable that although inter-beat interval,
heart rate variability and baroreceptor reflex
sensitivity (indices of heart activity) all
increase, blood pressure also increases. This
suggests that the changes in blood pressure
can be explained by changes in vascular fac-
tors after reflexology.
Anxiety levels decrease in both the reflexol-
ogy and foot-massage groups after interven-
tion in each session. However, no change was
observed in the waiting control group. Both
types of massage were rated equally as highly
pleasant, although reflexological massage was
evaluated as painful as well.
Both heart rate variability and baroreceptor
reflex sensitivity are indices of parasympathet-
ic cardiac control.22,28,37 Thus, the increased
heart rate variability and baroreceptor reflex
sensitivity during our three experimental
manipulations point to an increase in cardiac
vagal activity that is not specific to reflexology
since it also occurred during the foot-massage
and even the normal habituation process. So at
a conservative level, we can speculate that
most of this parasympathetic effect can be
explained as due to habituation to the labora-
tory environment.
Our results concerning baroreceptor reflex
sensitivity are contrary to those observed by
Article
Table 1. Mean systolic blood pressure differences between conditions for each of the
experimental periods. Post-hoc comparisons were performed with the Bonferroni proce-
dure. R, reflexology; M, foot massage; C, control group.
Session 1 Session 2 Session 3
Pre Post Pre Post Pre Post
R versus M 11.24 20.95** 13.82*21.21** 12.97 23.98**
R versus C 7.68 13.93*5.65 15.24** 8.17 13.79*
M versus C -3.55 -7.02 8.18 -5.97 -4.79 10.19
P*<0.05, **<0.01
Table 2. Results of the 3(¥3¥2) repeated measures ANCOVA for diastolic (DBP) and
mean blood pressure (MBP). The baseline value during the first session was introduced
as covariable. Simple main effects (T=Time, S=Sessions and C=Condition) and signifi-
cant interactions are displayed.
DBP MBP
FPη2FPη2
T 10.96 0.002 0.229 9.52 0.004 0.205
S 2.01 0.148 0.101 3.31 0.048 0.155
C 3.25 0.049 0.128 3.84 0.030 0.172
T¥C 4.75 0.015 0.204 5.43 0.009 0.227
T¥S 13.10 <0.0001 0.421 8.35 0.001 0.317
Figure 5. Inter-beat interval during the three sessions as a function of conditions. Bars
indicate standard errors of the mean.
Figure 6. Heart rate variability (RMSSD) during the three sessions as a function of con-
ditions. Bars indicate standard errors of the mean.
Non-commercial use only
[Alternative Medicine Studies 2012; 2:e4] [page 15]
Frankel.35 Although not specific to reflexology,
we have found an increase in baroreceptor
reflex sensitivity while Frankel35 found
decreases in this parameter after reflexology.
This contradictory result may be due to the dif-
ferent techniques used to assess baroreflex
function. Our method, the sequence tech-
nique,36,46,50 is based on the non-invasive
analysis of spontaneous covariation of systolic
blood pressure and inter-beat interval through
a continuous beat-to-beat recording of blood
pressure. Frankel35 used the Valsalva manoeu-
vre, an older and invasive technique based on
respiratory manipulations that produces an
indirect baroreceptor reflex sensitivity index.
As an indication of the validity of our proce-
dure, in the present study we found correla-
tions of about r=0.683 between baroreceptor
reflex sensitivity and inter-beat interval and
r=0.843 between baroreceptor reflex sensitivi-
ty and heart rate variability, which are totally
congruent with expectations based on physiol-
ogy.28,37 Frankel35 on the other hand found a
negative relation between his baroreceptor
reflex sensitivity index and respiratory sinus
arrhythmia, which is contrary to current phys-
iological knowledge.28,37
Our results concerning heart rate variability
are consistent with those of Delaney et al.40 who
also found increases in heart rate variability
after myofascial trigger-point massage.
However, our results are contrary to those of
Joseph et al.38 and Zhen et al.39 who found
decreases in heart rate variability during reflex-
ology in comparison to a relaxed sitting posi-
tion. This difference could be explained by the
differential experimental procedures being
used. Firstly, in these two last studies the mas-
sage was performed by a mechanical reflexolog-
ical device while in our study it was carry out by
an expert reflexologist. Secondly, they meas-
ured heart rate variability during the actual
massage while in our study physiological meas-
urement was carried out just before and after
massage. Continuous foot stimulation during
reflexology probably produces phasic cardiac
responses that could interfere with a reliable
measure of heart rate variability.26 As regards
inter-beat interval, the observed decrease is in
accordance with previous studies.7,41
The increase observed in blood pressure after
reflexological massage is not consistent with
previous results, which usually reported
decreases in blood pressure in response to
reflexology as well as to other kinds of mas-
sage.7,41,42,51-55 This difference might be
explained by the specific reflex-points being
stimulated and the strength and depth of the
procedure. In our study the circulatory area was
one of the selected points and, as shown by the
pain ratings, the massage was performed in
depth. It could be argued that the increase in
blood pressure provoked by reflexology could be
a response to pain and negative feelings during
Article
Figure 7. Baroreceptor reflex sensitivity during the three sessions as a function of condi-
tions. Bars indicate standard errors of the mean.
Figure 8. State-anxiety ratings during the three sessions as a function of conditions. Bars
indicate standard errors of the mean.
Figure 9. Ratings of pain evoked by the two massage procedures. Bars indicate standard
errors of the mean.
Non-commercial use only
[page 16] [Alternative Medicine Studies 2012; 2:e4]
the intervention. Pain is associated with
increases in blood pressure56 and it might
explain at least in part the increase in blood
pressure after reflexology. However, pain is also
accompanied by decreases in inter-beat interval,
heart rate variability and baroreceptor reflex
sensitivity,56 which contrast with the actual
changes observed in these parameters.
Furthermore, participants in the reflexology
group also rated the massage as pleasant and
their state anxiety decreased after the interven-
tion. In fact, no differences were found between
reflexology and foot massage groups in terms of
anxiety and pleasantness ratings. Altogether the
observed increases in inter-beat interval, heart
rate variability and baroreceptor reflex sensitivi-
ty and the self-reported data suggest that the
pain hypothesis can be discarded in our study.
An underlying physiological mechanism in
the explanation of the therapeutic effects of
reflexology and massage therapies in general
may be that they evoke a relaxation
response.13 Relaxation is known to have sever-
al beneficial effects such as an increase in
parasympathetic activity, a decrease in sympa-
thetic activity, catecholamine and cortisol lev-
els, immunologic potentiation, etc.57 All these
effects promote the normalization/balancing of
any deficiency and allow the body to function
more efficiently.57 The decrease observed in
state anxiety along with the changes in inter-
beat interval, heart rate variability and barore-
ceptor reflex sensitivity (that suggests an
increase in parasympathetic tone), which we
observed in the reflexology and foot massage
groups are congruent with this hypothesis.
However, the associated increase in blood
pressure due to reflexology is contrary to a
relaxation response and suggests that the
therapeutic effect of reflexology is different
and cannot simply be assimilated to the relax-
ation response. Therefore, reflexology seems
to act through a different mechanism.
As previously stated, the increase in heart
rate variability and baroreceptor reflex sensi-
tivity suggest an increase in cardiac vagal
activity after our three experimental condi-
tions. The increase in blood pressure associat-
ed specifically with the reflexology therapy
suggests a simultaneous activation of sympa-
thetic cardiac control. In this way, one of the
main findings of the study is the occurrence of
a co-activation of both branches of the
Autonomic Nervous System (ANS) after reflex-
ology. Co-activation of the two branches of the
ANS is one of the multiple possible modes of
autonomic functioning within a 2-dimensional
(sympathetic / parasympathetic) space.58 One
might speculate that reflexology strengthens
the balance of the ANS and makes it work in
equilibrium with superior level of activity of
both branches. This overall higher activity of
the ANS would help to optimize homeostatic
activity and increase the organism’s capacity
to respond adaptatively to internal and exter-
nal challenges.
Reflexology is believed to stimulate a healing
process, probably by potentiating a homeostatic
mechanism that restores health status. Blood
pressure is associated with the delivery of nutri-
ents, oxygen and energy to the tissues as well as
the removal of damaging toxins from the body.
One could speculate that the start of a healing
process, as with any other adaptive processes,
needs some additional energy resources. In this
way the increase in blood pressure is a useful
mechanism to mobilize and distribute this need
for supplemental energy.
Reflexologists claim that the healing effects
that this technique may generate are accumula-
tive. Our findings show that the increases pro-
duced by reflexology on blood pressure increas-
es the more sessions are performed. Most previ-
ous studies tested the efficacy of reflexology
after just one session. Our results confirm the
idea of an accumulative effect of reflexology59
and suggest the necessity of including several
sessions in future investigations.
Finally, an unexpected and surprising result
from our study is the increase in inter-beat
interval, heart rate variability and baroreceptor
reflex sensitivity found in the waiting-time con-
trol group. This clearly shows that the habitua-
tion process associated simply with the course
of time is able to produce significant changes in
cardiovascular variables that resemble some of
the changes associated with massage. This
result is of relevance and suggests the need for
the addition of waiting-time control groups in
future studies on the effects of alternative ther-
apies on physiological indices. Similarly, the
observed decrease in blood pressure over the
sessions regardless of the condition could also
reflect a more long-term habituation process to
the laboratory situation.
To conclude, the results of this study show
that reflexology, foot-massage and even simply
the passing of time increase inter-beat inter-
val, heart rate variability and baroreceptor
reflex sensitivity, resulting in relaxation-like
changes. However, reflexology specifically is
associated with an increase in blood pressure
not observed in the other conditions. These
results suggest that reflexology is associated
with a co-activation of the two branches of the
ANS, which, combined with the increased sup-
ply of energy associated with the rise in blood
pressure, may help optimize homeostatic
activity and promote the healing process.
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Article
Non-commercial use only
... Reflexology is a beneficial and non-invasive method and is can save time and energy [17,[25][26][27]. Reflexology is considered part of nursing care and can serve to improve the quality of the nurse-patient relationship [25,26,[28][29][30]. Nurses serve as crucial members of clinical teams in managing complications. ...
... Complementary Therapies in Clinical Practice 36 (2019) [29][30][31][32][33] the demographic characteristics were used. The independent t-test was used to compare the mean scores between the two groups. ...
... Complementary Therapies in Clinical Practice 36 (2019)[29][30][31][32][33] ...
... Nowadays, complementary and alternative medicines (CAM) are becoming more and more popular due to their uncomplicated, tolerable, and minimal interference with other treatments and medicines [22]. CAMs, as defined by the world health organization (WHO), are the knowledge, skills, beliefs, and experience of indigenous peoples in different cultures used for maintenance of health, prevention, rehabilitation, or physical and mental treatment [23]. ...
... • There is no medical prohibition for intervention such as foot ulcers, impotence, and orthopedic problems [29,39]. • Lack of debilitating chronic diseases (cancer, chronic respiratory failure, heart failure, rheumatoid arthritis, lupus erythematosus) [22,29]. • Married and living with a spouse [11,34,40]. ...
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Sexual problems of hemodialysis patients are one of the most significant factors affecting their quality of life and families. On the other hand, an essential part of the quality of life is the quality of sexual life and sexual dysfunction that will affect people's perception of the quality of sexual life. Reflexology massage is one of the complementary and alternative therapies combined with conventional medical treatments to reduce disease and treat its complications. This study aimed to determine the effect of foot reflexology on hemo-dialysis patients' quality of sexual life. This was a parallel randomized sham-controlled trial which conducted in hemodialysis center of Imam Reza (AS) Hospital in Sirjan, Iran. Forty-seven patients under hemodialysis were divided into two groups of foot reflexology (n = 24) and sham (n = 23) using block randomization method. The intervention group received foot reflexology treatment during dialysis for 4 weeks, 3 times a week, 30 min each time (15 min per foot). In the sham group, non-specific foot massage was conducted without squeezing the standard points of reflexology with the same conditions and duration as the intervention group. Quality of sexual life was assessed using female sexual quality of life questionnaire (SQOL-F) and male sexual quality of life questionnaire (SQOL-M) before the intervention, immediately, and one month after the intervention. The results showed that the quality of sexual life of participants in the reflexology group immediately after the intervention (69.74) was significantly higher than before (47.73) and one month after the intervention (52.27). There was no significant difference in the average quality of sexual life of participants in the sham group at different times (before intervention 46.67, immediately after intervention 45.66, and 1 month after intervention 48.18). Immediately after the reflexology intervention, the quality of sexual life was significantly higher than in the sham group (p < 0.001). This study highlights the potential benefit from reflexology in improving the quality of sexual life in patients undergoing hemodialysis. Trial registration IRCT20200712048085N1. Registered 15 July 2020, https:// en. irct. ir/ trial/ 49604
... In the present study, the participants were children aged 3-12 years; however, the previous studies included neonatal participants whose differences in response to foot reflexology were different [20,30]. Padial et al. (2012) also stated that foot reflexology massage increased children's anxiety and physiological parameters. They believed that foot reflexology stimulates the sympathetic and parasympathetic nervous systems; thus, increasing the HR. ...
... They believed that foot reflexology stimulates the sympathetic and parasympathetic nervous systems; thus, increasing the HR. The results of this study are inconsistent with those of the present study [31]. The results of the study by Khazaei et al. (2019) showed that foot reflexology twice a day for 2 weeks could reduce the rate of neuropathic pain in women with cancer, undergoing chemotherapy [32]. ...
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Background: Foot reflexology is a popular complementary medicine method; however, previous studies have shown conflicting results. This study aimed to investigate the impact of foot reflexology on pain and physiological responses caused by intrathecal injection of chemotherapy drugs in children with leukemia. Materials and methods: This clinical trial included 80 children with leukemia. The participants received 20 min foot reflexology (10 min each foot). The primary measured outcomes included pain and physiological indicators (blood pressure and heart rate). Results: The results showed that foot reflexology had a significant effect on reducing pain (p = 0.002) and improving physiological indicators [blood pressure (p = 0.002) and heart rate (p = 0.003)]. Conclusion: Based on the results of the present study, which shows the positive effect of foot reflexology on the improvement of pain and physiological indicators, foot reflexology can be used as a complementary treatment along with conventional therapies.
... Drug therapies have their own side effects, and healthcare systems prefer to use nonpharmacological therapies to treat patients. Today, complementary and alternative medicine, as a tolerable, complication-free therapy with minimal drug interaction has become more popular [17]. ...
... Out of 110 patients undergoing hemodialysis in the study setting, 55 patients met the inclusion criteria. Inclusion criteria were patients aged 18-65 years [29], who did not use drugs for sexual problems [29], were at least 3 months on hemodialysis [30] three times a week, four hours each time [25,31], with no medical contraindications such as foot ulcers, amputation, and orthopedic problems [23,32], no debilitating and chronic diseases such as cancer, chronic respiratory failure, heart failure, rheumatoid arthritis, Lupus erythematosus [17,23], those who were married and living with a spouse [33][34][35], and with no known psychological problems such as depression and bipolar disorder according to the patient's self-declaration [29]. Exclusion criteria were medical contraindications (such as diabetic foot ulcers), death or divorce of a spouse, failure to perform the intervention in three consecutive sessions, and failure to complete the questionnaires. ...
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Full-text available
Introduction: Hemodialysis patients experience sexual dysfunction due to the nature of their disease and its complications. Dialysis patients have reported sexual dysfunction as one of the most important stressors, which leads to many psychological and physiological problems. Sexual function in hemodialysis patients has been improved with pharmaceutical and nonpharmacological therapies. Foot reflexology is a complementary and alternative treatment that can be used in conjunction with contemporary care. By activating the chemical nerve system, reflexology may balance enzymes and regulate endocrine function. Objectives: To determine the effect of foot reflexology on the sexual function of hemodialysis patients. Methods: This randomized controlled trial was conducted on 47 patients on chronic hemodialysis referred to Imam Reza Hospital in Sirjan, Iran, who were divided into two groups of reflexology (n = 24; male = 19 and female = 5) and sham (n = 23; male = 18, and female = 5). The intervention group received foot reflexology during dialysis for four weeks, three times a week, 30 minutes each time (15 minutes per foot). The sham group received nonspecific foot massage without applying pressure on standard reflex points with the same condition and duration as the intervention group. The international index of erectile function and female sexual function index was assessed before, immediately, and one month after the intervention. Results: The results showed that immediately after the intervention, male orgasm function, sexual desire, and intercourse satisfaction in the reflexology group was significantly higher than those of the sham group. There was no significant difference between the two groups regarding erectile function and overall satisfaction. Furthermore, there was no significant difference between the two groups in terms of different aspects of female sexual function. Conclusions: Foot reflexology, as an effective intervention treatment, can reduce some aspects of sexual dysfunction of male patients under hemodialysis.
... Reflexology as the stimulation of some parts of the feet and hands associated with various organs is based on the Ingham method of reflexology (17). Reflexology provokes the chemical system of nerves, balances enzymes, and regulates the endocrine function (18). Reflexology aims to achieve free energy flow in different organs associated with pressure points. ...
... (4.38), P = 3.07, P = 0.48, respectively) (Table 2). However, after the intervention, the mean RLS score significantly reduced in the experimental group, while this score remained relatively unchanged in the placebo group (19.77(3.04) vs. 18.26 (4.91), P = 0.02). ...
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Background: Restless leg syndrome is an ordinary complaint among patients undergoing hemodialysis. Reflexology is a nursing intervention that can reduce the restless leg syndrome. This study aimed at investigating the effect of foot reflexology on the severity of restless leg syndrome in patients undergoing hemodialysis. Methods: A randomized controlled trial with a before-and-after design was conducted in hemodialysis patients attending a hospital in an urban area of Iran in 2016. Using a random sampling method, 72 female patients were divided into the experimental and placebo groups (n = 36 in each group). The patients in the experimental group received foot reflexology. In the placebo group, simple foot reflexology without pressing certain parts of the foot was conducted. The restless leg syndrome questionnaire was used to measure the severity of restless leg syndrome before and after the intervention. Statistical analysis was performed using SPSS v. 21 software. Results: After the intervention, the score of restless leg syndrome in the experimental group reduced compared to the placebo group (P = 0.02), while the group score of restless leg syndrome showed no statistically significant difference between the experimental and placebo groups (P = 0.84). Conclusions: Foot reflexology can be used as a safe and non-pharmacologic nursing intervention in reducing the restless leg syndrome among female patients undergoing hemodialysis.
... 16 Once the science and art are combined, the level of care quality is maximized. 17 Reflexology is one of the six widely used complementary and alternative therapies in Norway, Denmark, the United Kingdom, and the United States. 18 Accordingly, the energy flows through the vertical areas throughout the body of the foot to the head and applying pressure to a reflex point in the hand or foot can affect all organs, including the glands, bones, and muscles. ...
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Introduction: High prevalence of psychiatric disorders and the high effectiveness of electroconvulsive therapy (ECT) have made this treatment a useful intervention. Memory impairment, headache, and muscle pain are the most important complications after ECT. This research aimed to determine the effect of reflexology on the headache and muscle pain intensity of patients after receiving ECT. Methods: This randomized controlled trial was conducted in Razi teaching hospital of Urmia, Iran. A total of 56 patients with depression receiving ECT were randomly assigned into two equal groups of control (n=28) and intervention (n=28). In the intervention group, reflexology was performed for 20 minutes at reflex points and, in the control group, only the conventional measures were taken. Pain intensity was measured with visual analogue scale (VAS) before and 1, 6, and 24 hours after the intervention. Data were analyzed using the SPSS software version 13. Furthermore, chi-square, Mann-Whitney, Wilcoxon, and repeated-measures tests were performed. Results: The mean difference in the severity of headache and muscle pain in the intervention group was significantly reduced compared to the control group. Moreover, the results demonstrated a significant difference between the mean headache and muscle pain in the two groups after the intervention. Conclusion: The results of this study showed the positive effect of reflexology on reducing the intensity of pain in patients receiving ECT. Thus, it is recommended that nurses, health care providers, and caregivers use reflexology to reduce pain in patients with depression receiving ECT.
... Oxytocin inhibits pituitary, adrenal, hypothalamic, and alpha-adrenergic activities. This hormone also reduces the level of catecholamine that increases blood pressure and cardiac output (113)(114)(115)(116)(117)(118). ...
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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.
... Interestingly, one study investigated the cardiovascular effects of reflexology in healthy people illustrated that foot reflexology could increase BP and HR [43]. The investigators interpreted this finding as a positive outcome because reflexology co-activates two branches of autonomic nervous system which could be useful in enhancing hemostasis and healing process. ...
... Interestingly, one study investigated the cardiovascular effects of reflexology in healthy people illustrated that foot reflexology could increase BP and HR [43]. The investigators interpreted this finding as a positive outcome because reflexology co-activates two branches of autonomic nervous system which could be useful in enhancing hemostasis and healing process. ...
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BACKGROUND AND OBJECTIVE: Maintaining the stability of vital signs in stroke patients with modern non-pharmacological methods is of great importance. Therefore, the present study was conducted to determine the effect of foot massage duration on the vital signs of patients with cerebrovascular accidents in intensive care unit. METHODS: In this clinical trial, 64 patients were randomly divided into two groups (32 people) of interventions 1 and 2. Samples were selected from patients with cerebrovascular accidents who had reduced levels of consciousness and were admitted to the intensive care unit. In group 1, 5 min and in group 2, 10 min four-step foot massage was performed similarly. In both groups, vital signs were measured 2 minutes before the massage and in the first and fifth minutes after the massage. FINDINGS: The mean of heart rate (62/10 ± 79 and 72/9 ± 50/76) and respiration (15.03±3.02 and 16±3.2) in the intervention (1 and 2) groups First and fifth minutes after massage decreased (P <0.001). Mean arterial pressure in the intervention group 2 (92.09±12.63 and 95.15±12.54) decreased in the first and fifth minutes after massage (P <0.001). Body temperature in group 1 at 5 min after massage (36.95 ± 0.36 and 36.99± 0.37) decreased (P = 0.005). There was no statistically significant difference between the two groups in changes in physiological parameters. CONCLUSION: The duration of the foot massage did not affect the persistence of vital signs, and short-term massage had the same effect as long-term massage.
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A variety of evidence shows that the amplitude of respiratory sinus arrhythmia (RSA)—the peak-to-peak variations in heart rate caused by respiration—is a valid and reliable index of para-sympathetic cardiac control. An on-line program to calculate RSA amplitude on a breath-by-breath basis is described. The validity of the RSA amplitude values obtained through the computer pro-gram were tested in two studies. From the first one, the correlations between RSA amplitude and a set of cardiorespiratory variables, under both rest and auditory stimulation conditions, are reported. In the second study, the effect of atropine administration on the RSA amplitude, under both rest and mental load conditions, was examined. The results of both studies are con-gruent with predictions and suggest the usefulness of the software.
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Analysis of heart rate variation (HRV) has become a popular non-invasive tool for assessing the activities of the autonomic nervous system (ANS). HRV analysis is based on the concept that fast fluctuations may specifically reflect changes of sympathetic and vagal activity. It shows that the structure generating the signal is not simply linear, but also involves non-linear contributions. These signals are essentially non-stationary and may contain indicators of cardiac health. This work is an attempt made to do a quantitative study on the effect of reflexology on the heart rate variability (HRV) during reflexologic stimulation. The non-linear parameters are evaluated for this study and the results obtained for 20 subjects are tabulated. Résumé L'analyse de la variation de fréquence cardiaque (HRV) est devenue un outil non invasif très répandu pour évaluer les activités du système nerveux autonome. L'intérêt de la HRV réside dans le fait que les fluctuations rapides peuvent spécifiquement refléter des changements d'activité des systèmes sympathique et vagal. Elle prouve que la structure produisant du signal n'est pas simplement linéaire et met en jeu des fonctionnements non-linéaires. Les signaux sont essentiellement non stationnaires et peuvent refléter des dysfonctionnements cardiaques. Ce travail tente de faire une étude quantitative de l'effet des stimulations réflexologiques sur la variabilité de la HRV. Les paramètres non linéaires sont évalués dans cette étude et les résultats obtenus pour 20 sujets sont présentés.
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The electrocardiogram is a representative signal containing information about the condition of the heart. The shape and size of the P-QRS-T wave, the time intervals between its various peaks, etc., may contain useful information about the nature of disease afflicting the heart. However, the human observer cannot directly monitor these subtle details. Besides, since bio-signals are highly subjective, the symptoms may appear at random in the time scale. Therefore, the heart rate variability signal parameters, extracted and analyzed using computers, are highly useful in diagnostics. Analysis of heart rate variation (HRV) has become a popular non-invasive tool for assessing the activities of the autonomic nervous system. HRV analysis is based on the concept that fast fluctuations may specifically reflect changes of sympathetic and vagal activity. It shows that the structure generating the signal is not simply linear, but also involves nonlinear contributions. This work is an attempt made to do a quantitative study on the effect of reflexology on the HRV during reflexologic stimulation. The nonlinear parameters are evaluated for this study and the results obtained for 20 subjects are tabulated.
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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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High blood pressure is associated with elevated anxiety, stress and stress hormones, hostility, depression and catecholamines. Massage therapy and progressive muscle relaxation were evaluated as treatments for reducing blood pressure and these associated symptoms. Adults who had been diagnosed as hypertensive received ten 30 min massage sessions over five weeks or they were given progressive muscle relaxation instructions (control group). Sitting diastolic blood pressure decreased after the first and last massage therapy sessions and reclining diastolic blood pressure decreased from the first to the last day of the study. Although both groups reported less anxiety, only the massage therapy group reported less depression and hostility and showed decreased urinary and salivary stress hormone levels (cortisol). Massage therapy may be effective in reducing diastolic blood pressure and symptoms associated with hypertension.
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This paper outlines two pathways through which social support can influence the prevention or progression of cardiovascular disease: health behaviors and neuroendocrine mechanisms. Its primary focus is on neuroendocrine pathways, reviewing data which suggest that lack of social support is etiologically related to coronary artery lesion development through two mechanisms: sympathetic-adrenomedullary influences on platelet function, heart rate and blood pressure in the initial endothelial injury; and pituitary-adrenal cortical factors involved in smooth muscle cell proliferation during progression of the lesion after injury has taken place. It hypothesizes that the buffering effect of social support on the cardiovascular system is mediated primarily through mechanisms associated with the release of oxytocin.
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Respiratory sinus arrhythmia (RSA) has been used as an index of parasympathetic cardiac control. However, recent psychophysiological research casts serious doubts upon the usefulness of RSA as an index of vagal influences upon the heart in psychophysiological as well as in clinical studies. It suggests the need to look for another measure. In this exploratory study we investigated whether the baroreflex sensitivity (BRS) could serve as an alternative tool to investigate between-subject tonic parasympathetic influences on the heart. In nine healthy subjects we examined the effects of intravenous atropine (0.03 mg/kg i.v.), intravenous metoprolol (10–15 mg i.v.), and of saline as a placebo condition upon RSA, BRS, and related cardiovascular and respiratory variables, both under resting and under mental task conditions. After parasympathetic blockade, RSA and BRS display values near zero, showing their vagal origin. After beta-adrenergic blockade, when heart period is predominantly under vagal control, RSA fails to predict heart period variability. Using BRS, however, it is possible to predict more than 97% of heart period variance during beta-blockade. Finally, both the vagal and beta-adrenergic blockade show that BRS is a better predictor of parasympathetic cardiac control during blood pressure increases than during blood pressure decreases.