EVALUATION OF THE EFFICACY OF CARDAMOM AROMATHERAPY ON AEROBIC FITNESS & AUTONOMIC FUNCTIONS AMONG STUDENTS. 1 2 1

Abstract

Introduction: Aromatherapy is categorized as a form of complementary and alternative medicine (CAM), and has been steadily gaining popularity in today's society. Aromatherapy is considered by many to promote comfort, well-being and invigorating. However there appears to be insufficient supporting evidence to validate physiological changes that may reflect invigoration.
Objectives: This study examined the physiological effects of cardamom (Elettaria cardamomum) aromatherapy as indicated by heart rate variability. Aerobic fitness is one of the non invasive and simplest parameters which help in accessing one's fitness. In this present study we have also evaluated the efficacy of aromatherapy on the individual's physical fitness.
Methods: Total thirty healthy college students were selected as a subject who has attended four sessions in random order involving only exercise, aromatherapy and exercise combined. Each intervention lasted 15 minutes. Heart rate data were recorded for all sessions, and heart rate variability was analyzed. Aerobic fitness parameters also evaluated with the help of standard methods.
Results: There was statistically significant difference in LF/HF between the two intervention studies. During this aromatherapy, physiological responses such as oxygen consumption, respiratory exchange ratio and minute ventilation were significantly altered among different groups. Aerobic fitness was observed higher in aromatherapy combined exercise group against the only exercise group.
Conclusion: These results suggest significant physiological effect of cardamom (Elettaria cardamomum) aromatherapy interventions occurs in the autonomic nervous system as indicated by heart rate variability. The present study demonstrates that good estimated aerobic fitness was independently associated with aromatherapy and exercise.

Full text

EVALUATION OF THE EFFICACY OF CARDAMOM AROMATHERAPY ON
AEROBIC FITNESS & AUTONOMIC FUNCTIONS AMONG STUDENTS.
1 2 1
Shrikant L. Patil , E. Sreekumaran , A.P. Krishna
1 Department of Physiology, K. S. Hegde Medical Academy, Nitte University, Mangalore - 575 018, INDIA.
2 Department of Life Sciences, University of Calicut, Calicut - 673 635, INDIA.
Correspondence:
Shrikant L. Patil
Department of Physiology, K. S. Hegde Medical Academy, Nitte University,
Mangalore - 575 018, INDIA. E-mail : shrikantlpatil@gmail.com
Abstract:
Introduction: Aromatherapy is categorized as a form of complementary and alternative medicine (CAM), and has been steadily gaining
popularity in today's society. Aromatherapy is considered by many to promote comfort, well-being and invigorating. However there appears to
be insufficient supporting evidence to validate physiological changes that may reflect invigoration.
Objectives: This study examined the physiological effects of cardamom (Elettaria cardamomum) aromatherapy as indicated by heart rate
variability. Aerobic fitness is one of the non invasive and simplest parameters which help in accessing one's fitness. In this present study we have
also evaluated the efficacy of aromatherapy on the individual's physical fitness.
Methods: Total thirty healthy college students were selected as a subject who has attended four sessions in random order involving only
exercise, aromatherapy and exercise combined. Each intervention lasted 15 minutes. Heart rate data were recorded for all sessions, and heart
rate variability was analyzed. Aerobic fitness parameters also evaluated with the help of standard methods.
Results: There was statistically significant difference in LF/HF between the two intervention studies. During this aromatherapy, physiological
responses such as oxygen consumption, respiratory exchange ratio and minute ventilation were significantly altered among different groups.
Aerobic fitness was observed higher in aromatherapy combined exercise group against the only exercise group.
Conclusion: These results suggest significant physiological effect of cardamom (Elettaria cardamomum) aromatherapy interventions occurs in
the autonomic nervous system as indicated by heart rate variability. The present study demonstrates that good estimated aerobic fitness was
independently associated with aromatherapy and exercise.
Keywords : Aromatherapy, autonomic function, aerobic fitness, exercise.
Introduction
Ancient writings provide insight into how religions and
cultures of old used the aroma of burning herbs, flowers,
tree leaves and other natural sources in their spiritual
practices. It is learnt from the Hebrew, Christian,
Buddhist and Hindu cultures more about these types of
1
ritualistic observances . All these cultures from around
the world had access to various plants from which to
develop a recipe for pleasing the nose and mind. They
assigned mystical energies to these plants and learned
over the ages which ones provided results and which
ones failed. They also provided us with instructions for
using aromas that were pleasing not only to the senses of
the human nose, but also to the senses of the Divine
forces in their lives. Incense sticks are part of the 16
essential offerings during a Hindu ritual. According to
2
Saurabh Bhattacharya each of these offerings has
symbolic spiritual significance and is offered to the Divine
in a particular order.
Physical activity is defined as any bodily movement
produced by skeletal muscles that result in energy
3
expenditure . Physical fitness can be defined in multiple
ways, such as a set of outcomes or traits that relate to the
3
ability to perform physical activity . Aerobic fitness
determines the degree of fatigue that almost everybody
experiences in daily life. The higher the aerobic fitness,
the less fatigue one experiences. Aerobic fitness is the
ability to sustain work for prolonged periods. In order to
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EVALUATION OF THE EFFICACY OF CARDAMOM AROMATHERAPY ON
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Original Article
NUJHS Vol. I, No.1-3, September 2011

enhance aerobic fitness, athletes are known to try a
variety of aids to enhance performance and boost their
chances of winning. The term ergogenic aids identifies
those agents or procedures which if followed before a
competition will potentially enhance the athlete's
4
performance .
Aromatherapy, another possible ergogenic aid, has been
growing in recent years and has received much attention
by both traditional and alternative medicine
practitioners. However, there is very little evidence
which supports or refutes the claims made by merchants,
5
practitioners, and manufacturers . Since smell is the least
6
understood of all our senses it is logical to understand
why the number of discrepancies exist within the lay and
scientific literature regarding the validity of
aromatherapy. Buckle et. al. (1998) argues that
aromatherapy is becoming more and more valuable in
holistic nursing practice and should be a part of nursing
7
protocols . Martin et. al. (1996) suggested that drawing
conclusions regarding aromatherapy is premature since
much of the data is qualitative as much of it is based on
pure historical content and anecdotal reports from
8
individuals . Researchers have argued against
aromatherapy secondary to the poor follow-up of clients
after sessions. Additionally many reports are purely
subjective in nature and cannot be considered truly
9
scientific .
Earlier it was demonstrated that inhaling peppermint is
reported to be a stimulant for increased energy which
would certainly benefit any athletic or non-athletic
10
individual during an exercise bout . By definition,
peppermint could be considered an ergogenic aid.
Lavender is marketed as an aroma which promotes
7
relaxation and a calming effect . As with any ergogenic
aid, multiple questions arise regarding legal and ethical
issues. Also important is the additive being used a
substance the athlete would normal consume or use in
4
everyday life . How effective are the aromatherapy and
environment conditioning fragrances? It has been said
that aromas from lavender, basil, cinnamon and citrus
flavor aid relax, whereas cardamom, peppermint, thyme
and rosemary invigorate. Ginger, cardamom, licorice and
chocolate are supposed to arouse a sense of romance,
11, 12
while rose combat depression . Stimulating or
invigorating odors such as cardamom, rosemary and
lemongrass affect the locus ceruleus with the resultant
release of noradrenalin into the brain and this has the
effect of arousal/waking up. Researchers at the Royal
Berkshire Hospital NHS Trust recently broke new ground
by studying the effects of aromatherapy in the intensive
care unit as a means of helping to alleviate anxiety and
13
stress .
The purpose of this pilot investigation was to examine
the potential benefits that common cardamom (Elettaria
cardamomum) aromas might have on basic physiological
measures before, during and after a 15-minute exercise
bout. There is little evidence in the literature addressing
the actual physiological responses after the introduction
of an aromatherapy during exercise. It was hypothesized
that cardamom (Elettaria cardamomum) aromatherapy
can induce significant changes in the autonomic activity.
Our main concern is to elucidate the effect of cardamom
aromatherapy is synergistic or antagonistic. It was
hypothesized that the effect of aromatherapy on heart
rate would be a greater alteration in autonomic nervous
system activity than the effect of exercise alone.
MATERIALS METHODS
Subjects: Sixteen male and fourteen female apparently
healthy college students volunteered to participate in
this investigation. Mean ages were 22.5 ± 0.8 for males
and 21.75 ± 0.9 for females. These students considered
themselves sedentary. In this investigation, an individual
was considered sedentary if he/she did not regularly
participate in physical activity more than two days per
week at equal to or greater than 60% of their maximal
heart rate. All subjects were familiar with exercise
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protocols and walking on a motorized treadmill. This
study was approved by the departmental review board
for institutional ethical committee. Informed consent
was obtained from every individual who has participated
in this study. Using an in-house designed questionnaire,
background information was gathered from the subjects.
Methods:
Anthropometric measurements: All subjects underwent
a clinical examination; weight, height, and waist and hip
circumferences have been measured. Blood pressure
was recorded by auscultatory method with a mercury
sphygmomanometer according to the American Heart
Association guidelines.
Measurement of Peak Expiratory Flow Rate (PEFR):
Peak expiratory flow rate was examined with an Airmed
peak-flow meter. The test was performed in standing
position holding the peak flow meter horizontally. A tight
fitting disposable cardboard mouthpiece was inserted in
the inlet nozzle. After proper rest, subject was requested
to take a deep breath and followed by exhalation as
forcefully as possible in one single blow into the
instrument. The procedure was repeated three times
and best of the three was recorded.
Measurement of Physical Fitness Index (PFI): PFI was
14
measured by Harvard step test . The standard procedure
for the original step test was modified and used with a
difference that the stepping height is reduced from 20
inches to 18 inches in the line of originator of the tests
who suggested that for evaluating subjects with body
surface area below 1.85sq.m, an 18 inches stool should
be appropriate. The subjects stepped up and down on a
stool at the rate of 30 complete steps per minute keeping
time to a metronome for duration of 5 minutes unless
one stops from exhaustion. The recovery pulse counts
were measured at 1 to 1.5, 2 to 2.5, 3 to 3.5 minutes
recovery. Physical fitness is scored as PFI = [Duration of
exercise in sec x 100] / [2 x (sum of 1 to 1.5 min., 2 to 2.5
min., 3 to 3.5 minutes recovery)].
Oxygen consumption (VO ), minute ventilation (VE) and
2
respiratory exchange ratio (RER) were obtained via open
circuit spirometry using a metabolic analyzer. HR (Heart
rate) was recorded using a Polar Heart Rate Monitor. A
motorized treadmill was used for the exercise mode. RPE
15
was obtained using the modified Borg scale .
Aromatherapy: In this treatment schedule the subject
has been categorized and in order to assess each
subject's olfactory sensation, they were asked to identify
three recognizable aromas: garlic, ginger and a control
[water with food coloring made to resemble other aroma
mixtures]. As subjects confirmed their olfactory
sensation by recognizing each aroma, their suitability for
participation was confirmed. After acclimatization to the
laboratory, subjects returned once per week for three
weeks. Each week cardamom (Elettaria cardamomum)
aroma was administered in a double blind fashion. The
administration of the cardamom essential oil was
delivered through a sealed plastic container with the oil
concentrated on a sterile cotton pad. Subjects inhaled
the aroma with only nose breathing. The procedure of
administration cardamom aromatherapy was modified
16
from the Pournemati P. et.al. . Each subject inhaled the
aroma for one minute and began walking on the
treadmill at a speed of 90.5 meters/minute for 15
minutes. At every three-minute interval, the subject's
HR, VO , VE and RPE were obtained and recorded. Also at
2
each interval the designated aroma was again
administered using the sealed container for a period of
60 seconds. After the 15-minute period was completed,
subjects walked for five minutes at a speed of 55.3
meters/minute. Recovery heart rates were obtained
until it was confirmed that subjects had returned to
within 15-20 beats of their pre-exercise heart rate.
Measurement of HRV parameters: The ECG was
recorded using lead II to obtain a QRS complex of
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sufficient amplitude and stable base line. ECG signals
were conveyed through an A/D converter (Biopac MP 30,
Biopac system) at a sampling frequency of 500 Hz to PC
and were analyzed
Statistical analysis: The data obtained were analyzed for
their statistical significance by one way ANOVA test and
paired t-test using SPSS. P<0.05 was considered the level
of significance.
RESULTS
The data represented in Table 1. highlights the
characteristics features such as age, height, blood
pressure and different habits of the subjects. In addition,
weight and height was obtained to determine the body
mass index of each subject, waist and hip measurements
are included to determine waist to hip ratio.
The information gathered from the subjects during the
interactive session clearly shows that few of them were
also got the addiction to the alcohol, caffeine, and
smoking. The collected information about the lifestyle
parameters such as food habits, walking habits, health
and sports habits and stress related conditions at the
college. It was demonstrated that students are having
poor attitude towards their lifestyle parameters and
highly sensitive to the stressful conditions.
Table 1 – Base line general features of selected students
Each subject completed three separate exercise bouts of
treadmill walking lasting 15 minutes. During each bout
subjects inhaled one of three samples in a double blind
fashion. Table 1 contains the data obtained from analysis
of expired gases Oxygen consumption (VO ) minute
2
ventilation (VE) and Respiratory Exchange Ratio (RER)
remained the same among all three trials.
Table 2 - Comparison of selected physiological
parameters among exercise and exercise combined
aromatherapy.
Table 1 shows the higher aerobic capacity in
aromatherapy group as compared to exercise group,
expressed by higher (P < 0.01) oxygen uptake and
physical fitness index.
Heat rate response can be found in Table 2. During
exercise, heart rate increased approximately 30 beats
per minute above pre-exercise rate for all three trials.
Based on the rate of exercise intensity which subjects
performed, this response was considered normal. The
exception to this increase was with the cardamom trial
which only elicited a 29 beat increase secondary to the
higher pre-exercise heart rate of 71 BPM as compared to
77 BPM for the exercise group.
Table 3. Heart rate and rating perceived exertion (RPE)
response in exercise and exercise combined
aromatherapy group.
Parameters Excercise Aromatherapy P
group combined exercise Value
Physical Fitness 44.5 ± 2.42 49.4 ± 1.41 P<0.01
Index (PFI)
VO max 29.6 ± 1.24 35.5 ± 3.79 P<0.01
2-1
(ml.kg min)
Peak expiratory 376.1±67.67 429.9±.42.91 P<0.01
flow rate (PEFR)
-1
(Lmin )
VE [L/min] 28.65 ± 2.7 32.16 ± 3.2 P<0.01
RER 1.55 ± 0.07 1.92 ± 0.08 P<0.01
Subjects (n) in each group, n= 30. The values are expressed as mean ±SD.
Particulars
Age (Years) 22 ± 0.5
Weight (kg) 58.7 ± 5.95
Height (cm) 159.5 ± 6.74
2
BMI (kg/m ) 23.2 ± 0.8
WHR (waist-hip-ratio) 0.69 ± 0.03
Systolic blood pressure (mmHg) 124 ± 10.68
Diastolic blood pressure (mmHg) 74 ± 2
Smoking 2 %
Alcoholics 1 %
Excess Caffeine 2 %
Subjects (n) in each group, n= 30. The values are expressed as mean ±SD.
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Subjective measures of the modified Borg Scale or Rating
of Perceived Exertion [RPE] were obtained and these
results demonstrated an increase for the aromatherapy
combined exercise group [3.7] compared to a [2.4] for
the exercise group. An RPE of 3 equates to a perception of
hard work. An RPE of 2 equates to a perception of light
17
work.
The results depicted in table.4, Data are reported as
medians and interquartile range. RR = standard normal
RR interval; LF, HF = low and high frequency power,
respectively; LF/HF = ratio of absolute LF power to HF
power values. Frequency ranges: LF: 0.04-0.15 Hz and
HF: 0.15-0.4 Hz.
According to the results presented in table. 4 It is
apparent that after the aromatherapy treatment blood
pressure shows significant changes in both systolic and
diastolic. There was also an increase in heart rate, LF and
LF/HF ratio. Apparently, treatment of aromatherapy
decreases parasympathetic nervous activity.
The differences in the heart rate and other parameters
between the two groups at baseline, before and after
exercise are shown in Table 4, indicating a significant
difference in LF between the exercise and exercise
combined aromatherapy groups before and after
exercise. The median LF, HF level in exercise combined
aromatherapy group was significantly higher than those
in the exercise group. The smaller HF and larger LF/HF
after exercise may indicate possible elevation of
sympathetic activity. All the other HRV measurements,
indicates significant difference between the cardamom
aromatherapy combined exercise and exercise group.
Table 4. Comparison of heart rate variability parameters
in the exercise combined aromatherapy group.
DISCUSSION
Aromatherapy uses concentrated essential oils extracted
from herbs, flowers, trees and other plants. The essential
oils are believed to have an effect on both psychological
and physiological level. Depending on the mix and blend,
18
this effect may be either to stimulate or relax .
Cardamom (Elettaria cardamomum) is also known as
cardamon; it is related to several spices, such as ginger
(Zingiber officinale), and consequently possesses some
similar therapeutic properties and benefits as ginger.
Some important neurotransmitters have been identified
in cardamom, aceylcholine and choline, which explain
herbal medicine's position that cardamom, may behave
as a stimulant to the nervous system, and uses it to help
prevent convulsions or spasms. Scientific studies have
shown that cardamom has a blood thinning action, due
18
to its high concentration of linoleic acid .
We found a significant increase in mean heart rate and
increases in analysis of heart rate variability parameters
after 15 min of cardamom inhalation. Moreover, HF is
Parameters Excercise Aromatherapy P
group combined exercise Value
Pre-exercise 77.23±8.5 71.64 ± 7.7 P<0.1
heart rate
Exercise Heart 100.23 ± 8.7 100.9± 9.3 P<0.1
Rate
Time of running 12.45 ± 1.2 14.30 ± 0.9 NS
(minute)
RPE 2.4 ± 0.8 3.7 ± 0.8 P<0.1
Subjects (n) in each group, n= 30. The values are expressed as mean ±SD.
Subjects (n) in each group, n= 30. The values are expressed as mean ±SD.
*P < 0.05; **P < 0.01; ***P < 0.001.
Parameters Exercise group Aromatherapy
combined exercise
Pre- Post- Pre- Post-
exercise exercise exercise exercise
Heart Rate 69.32 ± 76.05 ± 78 ± 82.7 ±
(BPM) 8.75 6.11 10.49* 15*
2
LF(msec ) 357.55 ± 305.88 ± 534.64 ± 370.27 ±
** ***
159.84 227.74 567.80 257.52
2
HF(msec ) 1191.32 ± 399.18 ± 787.73 ± 482.36 ±
** **
1298.74 419.84 755.52 429.80
LF/HF 0.299 ± 0.764 ± 0.705 ± 0.968 ±
**
1.017 1.351 1.671 1.145***
Systolic blood 112.04 ± 129.52 ± 123.27 ± 139.09 ±
** **
pressure (mmHg) 17.29 11.31 11.16 6.49
Diastolic blood 74.32 ± 83.00 ± 78.82 ± 86.00 ±
**
pressure (mmHg) 8.72 6.89 8.94 6.72***
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also increased, and all these indices have been used to
reflect primarily sympathetic influences. LF has been
shown to reflect both sympathetic and parasympathetic
influences, making the contributive components of this
19, 20
measurement less clear . However, the change in LF
and ratio of LF/HF infer that there is an impact on
sympathetic drive to the heart.
In this present study we also investigated that the
differences in autonomic cardiovascular control could
appear between exercise and exercise combined
aromatherapy group during a situation of exercise stress,
which is a natural stimulus, leading to sympathetic
excitation and vagal withdrawal in the heart. During
exercise the initial increase in the heart rate response is
mediated by a decrease in vagal activity, followed by an
enhanced sympathetic activity that maintains higher
values of heart rate during the test.
The finding of increased low to high frequency (LF/HF)
ratio in response to cardamom aromatherapy indicates
that aromatherapy may in fact cause a sympathetic
response, rather than a parasympathetic response. This
finding warrants further research. Further, it is not
known what mechanisms play a role with aromatherapy
and metabolism. At 15 minutes of exercise the average
individual is just beginning to achieve a true point when
oxygen demands equal oxygen availability or more
commonly referred to as steady state of oxygen
17
consumption .
The use of aromatherapy is rapidly growing within
western society. It is obvious from the literature that
there are vast differences in opinion regarding the
efficacy, validity and the overall claims towards the role
of aromatherapy in all aspects of medicine, particularly
preventative and rehabilitative medicine. Exercise does
fall into both categories, preventive and rehabilitative;
therefore the use of aromatherapy in concert with
exercise is quite popular. Although it is claimed that
peppermint may accentuate energy by stimulating the
10
adrenal cortex it is not known what dosage and how this
increased energy may affect exercise performance.
Cardamom has reputation for having simulative effects
on autonomic bodily systems like digestion and
circulation. Cardamom may improve blood circulation to
the lungs, and is indicated in folk medicines to relieve
11-13
symptoms of asthma and bronchitis. Our study clearly
suggests that during dynamic exercise, heart rate
increases due to both a parasympathetic withdrawal and
an augmented sympathetic activity. The relative role of
the two drives spectral depends on the exercise
20-25
intensity.
In the present investigation, cardamom aromatherapy
had significant effect on resting or exercises heart rate
during 15 minutes of moderate treadmill walking. The
result of present study about rating perceived exertion
shows a slight increase in aromatherapy groups. Rating
perceived exertion is a good index for evaluating
15
individual's effort during an exercise bout .
Earlier study mentioned that inhaling the essential oil
can affect the performance in both positive and negative
20
ways and the cardamom essences is known as
aphrodisiac and invigorating which may be the reason for
increase in concentration and improves performance.
The results of this study indicate that inhaling a
cardamom essence has brought the significant
differences when compared to exercise group. The value
of respiratory exchange ratio indicates that fat is being
consumed for energy generation during exercise. It is
possible that cardamom aroma may have more
beneficial effects when fat are the major fuel source as
opposed to carbohydrate.
The higher aerobic capacity of the athletes was reflected
in greater oxygen consumptionand physical fitness index
in both groups. Also, the resting heart rate was
significantly lower in exercise combined aromatherapy
group than in exercise group. Changes in the intrinsic
mechanisms acting on the sinus node and alterations in
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the autonomic nervous system control of the heart have
23, 24
been reported to contribute to this phenomenon.
These data are exciting regarding aromatherapy and
exercise performance; however, given the above
limitations regarding time and introduction of aroma,
these results are understandable.
The benefits of aroma on exercise performance is not yet
established, the questions regarding their ethical use
must be addressed. However, further research on the
normal and strenuous exercise in combination with
appropriate control needs to be conducted to clarify the
efficacy of cardamom aromatherapy in the management
of well-being in combating with lethargy, sedentary life
style and or other health issues. Heart rate and other
cardiac variables should have been measured during
exercise to clarify physiological responses more in
details. We demonstrate the need of further research to
investigate subjects, measurement indicators, and
experimental conditions to clarify the relationship
between physiological and emotional responses
produced by cardamom aromatherapy.
CONCLUSION
Everyone experiences some degree of pressure at work,
and being under pressure can help improve performance
and productivity. Excessive levels of pressure, however,
can have adverse effects, resulting in stress and intense
long-lasting stress can lead to mental and physical ill-
health. In such situations, simple techniques that can
help to cope up with stress, such as aromatherapy, can be
of major benefit. We have demonstrated on young
healthy adults the effect of inhaling the aroma from
Cardamom (Elettaria cardamomum) essential oil on
autonomic balance. The results provided support for the
stimulatory effect of aroma, as indicated by a shift of the
autonomic balance toward sympathetic predominance.
Combining exercise with cardamom aromatherapy is not
only enjoyable because of its effects on mood but also
promotes physiological excitation, thereby increasing
physical activation. Inhalation of cardamom essential oil
may provide a relatively simple, safe, well-being,
invigorating and effective method of handling the
stressful conditions.
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Nitte University Journal of Health Science
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EVALUATION OF THE EFFICACY OF CARDAMOM AROMATHERAPY ON
AEROBIC FITNESS & AUTONOMIC FUNCTIONS AMONG STUDENTS.
NUJHS Vol. I, No.1-3, September 2011