Research Article Effects of Swedish Massage Therapy on Blood …downloads.hindawi.com/journals/ecam/2013/171852.pdf · 2019. 7. 31. · Effects of Swedish Massage Therapy on Blood

Hindawi Publishing CorporationEvidence-Based Complementary and Alternative MedicineVolume 2013 Article ID 171852 8 pageshttpdxdoiorg1011552013171852

Research ArticleEffects of Swedish Massage Therapy on Blood PressureHeart Rate and Inflammatory Markers in Hypertensive Women

Izreen Suparsquoat1 Zaiton Zakaria2 Oteh Maskon3

Amilia Aminuddin2 and Nor Anita Megat Mohd Nordin2

1 Faculty of Biomedical and Health Sciences Universiti Selangor Shah Alam Malaysia2 Physiology Department Universiti Kebangsaan Malaysia Medical Centre Kuala Lumpur Malaysia3Medical Department Cardiology Unit Universiti Kebangsaan Malaysia Medical Centre Kuala Lumpur Malaysia

Correspondence should be addressed to Izreen Suparsquoat izreensgmailcom

Received 23 August 2012 Accepted 21 July 2013

Academic Editor Ka Kit Hui

Copyright copy 2013 Izreen Suparsquoat et al This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

SwedishMassageTherapy (SMT) is known for its therapeutic relaxation effects Hypertension is associated with stress and elevatedendothelial inflammatory markers This randomized control trial measured the effects of whole body SMT (massage group) orresting (control group) an hour weekly for four weeks on hypertensive women Blood pressure (BP) and heart rate (HR) weremeasured before and after each intervention and endothelial inflammatory markers vascular endothelial adhesion molecules 1(VCAM-1) and intracellular adhesion molecules 1 (ICAM-1) were measured at baseline and after the last intervention Massagegroup (119899 = 8) showed significant systolic BP (SBP) reduction of 12mmHg (119875 = 001) and diastolic BP (DBP) reduction of 5mmHg(119875 = 001) after four sessions with no significant difference between groups Reductions in HR were also seen in massage groupafter sessions 1 3 and 4 with significant difference between groups VCAM-1 showed significant reduction after four sessions themassage group showed reduction of 99805 ngmL (119875 = 003) and the control group of 37570 ngmL (119875 = 001) with no significantdifferences between groupsTherewere no changes in ICAM-1 In conclusion SMTor resting an hourweekly has effects on reducingBP HR and VCAM-1 in hypertensive women

1 Introduction

Theprevalence of hypertension inMalaysia is increasing from329 in 1996 to 405 in 2004 for individuals above 30 yearsold [1] with a prevalence in women higher than men [2] In2004 43 of women over 30 years old are hypertensive [3]Hypertension is a major risk factor for cardiovascular disease(CVD) CVD is the primary cause of death in women inMalaysia as well as globally [4] In addition more womenexperienced the side effects of antihypertensive treatmentsuch as calcium channel blockers and angiotensin convertingenzyme inhibitors compared to men [4]

The development of primary hypertension has beenclosely associatedwith endothelial dysfunctionThiswas seenin the increased expression of interleukin 6 (IL-6) inter-leukin 1 (IL-1) tumour necrosis factor 120572 (TNF-120572) monocyte

chemoattractant protein 1 (MCP-1) VCAM-1 and ICAM-1 in hypertensive rats [5ndash7] VCAM-1 and ICAM-1 areimmunoglobulin superfamily (IGSF) molecules involved incell to cell adhesion VCAM-1 is expressed on endothe-lial epithelial macrophage and dendritic cells ICAM-1 isexpressed on endothelial epithelial fibroblast leucocytesand tumour cells VCAM-1 and ICAM-1 form attachmentsand assist transendothelial migration of leukocytes at sitesof atherosclerosis [8] These molecules are upregulated inresponse to inflammatory cytokines or oxidative low-densitylipoprotein (ox-LDL) [9] During an inflammation caused byinjury leukocytes will roll on the endothelium before firmlyadhering to the vessel wall Stable adhesion of leukocytesfurther upregulates adhesion molecules that will drive thetransmigration of leukocytes across the endothelium to thesite of injury Leukocytes adhesion is opposed by tangential

2 Evidence-Based Complementary and Alternative Medicine

tractive forces or shear stress induced by the blood flow veloc-ity gradient near the vessel wall [10]

Shear stress is defined as the tangential drag force of bloodpassing along the surface of the endothelium [11] Shear stressis directly proportional to blood viscosity and velocity andinversely proportional to blood vessel diameter (shear stress =blood viscosity times blood velocityvessel diameter) There aretwo types of shear stress the atheroprotective laminar orpulsatile shear stress which occurs in straight blood vessels[12] and the atherogenic oscillatory shear stress which occursat bends and bifurcation of arteries [13ndash15]The physiologicalatheroprotective shear stress is more than 15 dynecm2 In theevent of narrowing of the arteries the shear stress here is lowConsequently blood will rush out of the narrow opening athigh velocity and create a higher shear stress on the arterialwall therefore inducing endothelial-dependent nitric oxide-mediated vasodilation which brings the shear stress back tonormal However this effect is blunted in hypertensive andhypercholesterolemic patients [16] It was found that withincreasing shear stress the expression of VCAM-1 is lowand the expression of ICAM-1 is high There was also noleukocytes adhesion to the vessel wall In contrast if there is adecrease in shear stress the expression of VCAM-1 increasesand the expression of ICAM-1 decreases with leukocytesadhesion to the vessel wallThis is indicative of the early stageof development of atherosclerosis [17 18]

Swedish Massage Therapy (SMT) is a complementarytreatment that is believed to provide relaxation and thereforeable to reduce blood pressure caused by stress [19] It is themost recognised and frequent usedmassage therapy [20] It ischaracterised by long strokes applied according to the venousand lymphatic flow It is a painless gentle and nonforcefultechnique that is not associated with any serious adverseeffects [21]Massage therapy has been shown to decrease sym-pathetic activity and increase parasympathetic activity [22]Therefore this therapy is able to decrease anxiety and stress[23 24] In addition massage therapy is able to reduce bloodpressure (BP) and heart rate (HR) in hypertensive individuals[25ndash27] It also increases skin blood flow and suppleness andinduces tissue relaxation [28] The long strokes in massagecompress the body tissues and when released increase bloodflow to the local area [19]

The present study assessed the effects of SMT versus reston hypertensive women If SMT yields positive results in thisstudy it can be recommended as an adjunct or a complemen-tary therapy to the conventional management of hyperten-sion especially in women as the prevalence of hypertension inwomen is high [1 2] As far as the authorrsquos present knowledgeextends no studies have assessed the effects of whole bodySwedishMassageTherapy onhypertensivewomenonBPHRand inflammatory markers In view of the literature statedabove it was hypothesized that massage increases blood flowand thus increases shear stress on the blood vessel wall Theincrease in shear stress reduces the expression of VCAM-1and vWF and increases ICAM-1 In addition through theactivation of parasympathetic nervous system massage isable to reduce BP and HR Therefore Swedish Massage Ther-apy is expected to reduce BP HR and VCAM-1 and increaseICAM-1

2 Methods

21 Participants This study is an experimental randomizedcontrol trial that has been approved by the Ethics Commit-tee of the Universiti Kebangsaan Malaysia Medical Centre(UKMMC) (Project Ethics Code FF-280-2009) The par-ticipants were 35ndash60-year-old women recruited from theUKMMC records These women must fulfil the followingcriteria

(a) body mass index (BMI) of less than 35 kgm2(b) SBP of 120ndash159mmHg andDBPof 90ndash99mmHgwith

or without treatment If they are on antihypertensiveor anticholesterol medications they must be on onlyone medication of the same type and dose for at leastsix months

(c) normal liver thyroid and renal functions(d) not taking any prescribed andor traditional medi-

cations (apart from those stated in (b)) and supple-ments

(e) not smoking or drinking alcohol(f) no other illnesses(g) not pregnant(h) have not experienced Swedish Massage Therapy

Detailed explanation of the study was given to eachwoman All women had signed the consent form before par-ticipating in this study

The sample size is calculated based on paired samples thatis BP taken before and after intervention with continuousoutcomesThe formula used in this study is taken from Chan2003 [29]The values for this formula are taken from anotherstudy [26] with a similar topic and significant results Theminimum number of subjects calculated is 16 with 8 subjectsper group

Twenty-three women fulfilled the above criteria andwere screened for any health conditions that may influencetheir blood pressure Blood pressure of these women wasmonitored for two weeks prior to the intervention Bloodsamples were taken to ensure that the liver thyroid and renalfunction and the fasting blood glucose level were normalResting electrocardiogram (ECG) and stress tests were alsocarried out to ensure normal cardiac function Fasting bodycomposition was measured before and after the interventionto ensure that the body fluid distribution remains unchangedTwenty women successfully passed their screening Thesewomen were randomly assigned to two groups the massagegroup and the control group using random numbers gener-ated through the SPSS version 15 software However only 16women (8 per group) successfully completed the interven-tion

22 Intervention In this study the massage protocol is anhour of Swedish Massage Therapy to the whole body once aweek for four weeks An hour of massage allows enough timeto apply all the Swedishmassage techniques to thewhole bodywhich was expected to produce positive effects on BP and

Evidence-Based Complementary and Alternative Medicine 3

HR [30 31] Massage sessions once a week for four weeks areconsidered not too frequent as they prevent the subject fromshowing any signs of relaxation prior to the massage sessionas would be expected if the sessions are more frequent

Eight women in themassage group underwent an hour ofwhole body Swedish Massage Therapy once a week for fourweeks at the Clinical Trial Ward UKMMC A qualified mas-sage therapist with a certificate in Holistic Therapy from theInstitute of Bioproduct Development Universiti TeknologiMalaysia carried out the massage on each of the subjectsThe massage techniques used are a combination of petrissageor kneading tapotement or beatinghackingcupping andeffleurage or long strokes These techniques are applied atmedium pressure Olive oil was used as the lubricant Thesemassage sessions were carried out during working daysbetween 8 and 10 am The protocol used is described below

(1) The subject is requested to lie prone with only theright leg is exposed Massage oil applied on the ex-posed leg

(2) Long strokes are applied on the posterior right leg(3) The gastrocnemius muscle is kneaded using both

thumbs(4) Step (2) is repeated(5) The medial and lateral parts of back of the thigh are

(a) kneaded using the palm of the hand(b) hacked or striken with the medial side of the

hand(c) pounded using themedial side of a clenched fist

(6) Lymphatic drainage is then carried out by applyinglong strokes along the venous or lymphatic vesselstowards the nearest lymph nodes

(7) Step (2) is repeated(8) The left leg is covered and steps 1ndash7 are repeated on

the left leg(9) Massage is then carried out on the back Massage oil

is applied on the whole back(10) Long strokes are carried out using the palms of

therapist hands from the lower back to the shoulders(11) Kneading using fingers is applied parallel to the spine

from the lower back to between the scapulae(12) Step (10) is repeated(13) Kneading using palms is applied on both loin areas

and posterior to the lungs(14) Lymphatic drainage was carried out from the lower

back to the axillary and subclavicular lymph nodes(15) Step (10) is repeated(16) The subject is requested to turn over and lie supine

with the right leg exposed Massage oil is applied onthe whole leg

(17) Long strokes are applied on the anterior right leg

(18) The anterior tibialis muscle is kneaded using boththumbs

(19) Step (17) is repeated

(20) The biceps femoris is kneaded using the palm of thehand

(21) Step (6) and Step (17) are repeated

(22) Massage is then carried out on the abdomen wheremassage oil is applied

(23) Long strokes are applied from the umbilicus to thexiphisternum along the lower border of the ribstowards lateral of the abdomen and inferior towardsthe inguinal area

(24) Strokes are applied along the ascending transverseand descending colon

(25) Small circular kneading using tips of fingers isapplied clockwise around the umbilicus

(26) Lymphatic drainage is carried out through longstrokes from the posterior loin area to the inguinalregion


(28) Massage is then carried out on the right arm wheremassage oil is applied

(29) Effleurage is applied using one hand to support thesubjectrsquos arm and the other hand carrying out longstrokes from the wrist to the scapula region

(30) The forearm is kneaded using the thumb

(31) The upper arm is kneaded using the palm of the hand


(33) The subject is requested to sit up with her back to themassage therapist

(34) The massage therapy ends with massage to the scalpneck and shoulders

(35) The scalp is kneaded from the frontal area to theoccipital area using fingers

(36) The temples are kneaded in circularmotions using theheel of the hands

(37) The trapezius and deltoid muscles are kneaded ac-cording to the orientation of the muscle fibers usingfingers

(38) BP and HR were taken The subject is requested todress

Eight women in the control group underwent an hourof rest once a week for four weeks at the same ward and atthe same time They were instructed to lie supine and resteither doing light reading or sleep They are not allowed tolisten to any music watch television exercise or carry outany activities that may affect their BP


23Measurements Bloodpressure andHRwere taken beforeand after each massage and rest session and 48 hours afterthe last session Blood pressure was taken twice at five-minute interval using the mercury sphygmomanometer andHR through palpation

10mL of blood was collected in normal test tubes withno chemical preservatives at baseline that is before the firstmassage and rest session and after the last session endedThe blood was left to coagulate for two hours before beingcentrifuged at 3000 rpm for 10 minutes at 4∘C The serumis pipetted into 1mL Eppendorf tubes and stored at minus70∘Cbefore being analysed The level of soluble VCAM-1 andICAM-1 was analysed using kits through the enzyme-linkedimmunosorbent assay method (ELISA) The analysis pro-tocols were carried out as instructed in the kits VCAM-1 (BMS232TEN Bender MedSystems Austria) and ICAM-1 (BMS201INST Bender MedSystems Austria) The concen-tration of soluble VCAM-1 and ICAM-1 of each sample wascalculated through the SOFTmaxPRO software through themeasurements of the absorbance value of the study samplesthe standard samples and the control samples The normalrange of soluble VCAM-1 as stated in the kit is 4006ndash13408 ngmL and soluble ICAM-1 is 1299ndash2974 ngmL

24 Statistical Analyses Data were analysed using SPSSsoftware version 15 Due to the small number of samples(lt20) nonparametric statistical tests were used The Mann-Whitney U test was used to compare the readings betweenthe two groups and the Wilcoxon Signed Rank test wasused to measure the changes in each group For BP andHR the difference between the preintervention readings andpostintervention readings of each session is considered to bean acute change The difference between the preinterventionreadings of BP and HR of session 1 and preinterventionreadings of subsequent sessions is considered to be chronicchange A four week chronic change is the difference betweenthe preintervention reading of BP and HR of session 1 andreading 48 hours after session 4 All data is presented inmedian (interquartile range) The value of 119875 lt 005 isaccepted as the significant level

3 Results

31 Baseline Characteristics The baseline characteristics ofthe research participants are shown in Table 1 Women in themassage and control groups were comparable in all parame-ters except for a higher fasting blood glucose level in the latterHowever this was still within the normal range In generalthese women were overweight resting BP showed Stage1 hypertension and lipid profile showed high cholesteroland high LDL while HDL levels were normal More than62 were nonmenopausal In each group three participants(375) are on antihypertensive medications and only one(125) is on anticholesterol medication

32 SBP Changes Figure 1 shows the trend of SBP changesfor every session for both groups During session 1 therewas an acute significant reduction in the massage group from14300 (900)mmHg to 13800 (1675)mmHg (119885 = minus170

Table 1 Baseline characteristics of the research participants

ParametersMassagegroup(119899 = 8)

Controlgroup(119899 = 8)

119875

Age (years) 5100 (1000) 5113 (1100) 096Employed () 50 375 061Nonmenopausal () 625 75 059On antihypertensives () 375 375 100On anticholesterol () 125 125 100Resting SBP (mmHg) 14225 (1838) 14375 (750) 067Resting DBP (mmHg) 8125 (975) 8950 (1350) 053Resting HR (bpm) 6600 (1550) 7200 (300) 010BMI (kgm2) 2902 (665) 2815 (741) 083Cholesterol (mmolL) 580 (074) 642 (132) 013HDL (mmolL) 130 (042) 141 (020) 011LDL (mmolL) 395 (032) 444 (168) 049Fasting blood glucose(mmolL)lowast 495 (025) 550 (045) 001

Data in median (interquartile range) lowast119875 lt 001 is significant

119875 = 003) Chronic significant reduction was seen after thefirst week in the control group from 14000 (2375)mmHg to13700 (1175)mmHg with 119885 = minus252 119875 = 001 after thesecond and third weeks in both groups and after the fourthweek in the massage group only at 12mmHg (119885 = minus254119875 = 001)There was no significant difference in SBP readingsbetween massage and control groups

33 DBP Changes The trend in DBP changes is shown inFigure 2 During session 1 there was an acute significantDBP reduction of 7mmHg in massage group (119885 = minus238119875 = 002) During session 4 there was an acute significantreduction in the control group from 8150 (875)mmHg to8000 (525)mmHg with 119885 = minus203 119875 = 004 In additionchronic significantDBP reductionswere seen after the secondweek (minus2mmHg (119885 = minus221 119875 = 003)) the third week(minus8mmHg (119885 = minus254 119875 = 001)) and the fourth week(minus5mmHg (119885 = minus252 119875 = 001)) in the massage groupThere were no significant differences between the two groupsin all DBP readings

Figure 3 shows the trend of HR changesThere is an acutesignificant HR reduction in massage group after each sessionwith significant differences between groups after session 1(119885 = minus222 119875 = 003) session 3 (119885 = minus207 119875 = 004) andsession 4 (119885 = minus203 119875 = 004) Chronic reduction was seenin the control group after the first week (119885 = minus226 119875 = 002)with no significant difference between groups

34 VCAM-1 Changes The changes in the level of VCAM-1are displayed in Figure 4 Significant reduction in VCAM-1was seen in massage group from 198830 (91139) ngmL to99025 (67525) ngmL (119885 = minus220 119875 = 003) and thecontrol group from 142055 (86107) ngmL to 104485(60239) ngmL (119885 = minus252 119875 = 001) No significant changewas seen between groups


124126128130132134136138140142144

Pre Post Pre Post Pre Post Pre PostSession 1 Session 2 Session 3 Session 4

48 hrpost

session4

SBP

(mm

Hg)

Time

Massage groupControl group

143

140

141lowast138

Δ137

Δ134

Δ141

Δ134

Δ138

Δ131

++

Figure 1 SBP changes for each session for massage group andcontrol group lowast119875 lt 005 (acute changes within groups) and 998779119875 lt005 (chronic changes within groups) ++119875 lt 005 (baseline versusafter session 4)

747678808284868890


48 hrpost

session4

DBP

(mm

Hg)

Time

87

81

lowast875

lowast885

lowast815

lowast80

lowast80

Δ79

Δ85 Δ

82


Figure 2 DBP changes for each session for massage group andcontrol group lowast119875 lt 005 (acute changes within groups) and 998779119875 lt005 (chronic changes within groups)

35 ICAM-1 Changes No significant changes were seenwithin the two groups and between groups as shown inFigure 5

4 Discussion

Massage group showed chronic significant reduction in SBPafter two three and four weeks These results are consistentwith Olney (2005) [25] Hernandez-Reif et al (2000) [26]and Moeini et al (2011) [27] which showed that massagehad long-term effects on the BP of hypertensive patientsHowever the control group of this current study also showedchronic significant reduction in SBP after one two and threeweeks These results contradict the results of the authors

01020304050607080


48 hrspost

Session4

HR

(bpm

)

Time

72

64 lowast60

lowast70

lowast74

lowast

lowast

60

68

695

lowast62

lowast62

715 Δ

70


Figure 3 HR changes for each session for massage group andcontrol group lowast119875 lt 005 (acute changes within groups) 998779119875 lt 005(chronic changes within groups) and

119875 lt 005 (changes betweengroups)

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Week 0 Week 4Time


19883

V-CA

M 1

(ng

mL)

142055

99025lowast 104485

lowast

Figure 4 VCAM-1 changes for massage group and control grouplowast119875 lt 005 (reduction within groups)

mentioned Olney (2005) [25] Hernandez-Reif et al (2000)[26] and Moeini et al (2011) [27] showed no significantchanges in SBP of their control groups Several factors maybe able to explain these occurrences Firstly the rest sessionof this current study is of longer duration if compared to thestudies of Olney [25] and Moeini et al [27] Secondly duringthe resting period the subject is free to use any relaxationmethods and the researcher is only present during the pre-and postintervention measurements The combination of nosupervision and longer duration of rest may have reducedthe SBP of the control subjects Acute reduction in SBP of5mmHg after session 1 in the massage group was also seen


0

50

100

150

200

250

300

350

400

450

Week 0 Week 4Time

415

I-CA

M 1

(ng

mL)


365

300

370

Figure 5 ICAM-1 changes for massage group and control group

and this is consistent with the results of Hernandez-Reif et al(2000) [26]

In parallel with the results of SBP the massage group alsoshowed significant chronic reduction in DBP after two threeand four weeks of massage therapy and acute significantreduction of 7mmHg after session 1 In summary SMT is ableto reduce both SBP and DBP even though there is no signifi-cant difference between groups

Heart rate of themassage group was reduced significantlyafter each session and the changes were significant betweengroups after sessions one three and four Even though theduration of the massage session is different from other stud-ies these results are consistent with studies that measure theeffects of massage on normal individuals [22] breast cancerpatients [32] hospice patients [33] migraine patients [34]and critical care patients [35]

The reduction in BP and HR could be explained throughthe comfortable feeling and relaxation as well as the increasein parasympathetic activities induced bymassage as shownbyOuchi et al (2006) [22]This is supported by Diego and Field(2009) [36] who showed that the massage applied at mediumpressure for 15minutes caused increase in the high-frequencycomponent of HR variability which reflected an increase invagal activities In addition there was a decrease in the ratioof low-frequency component to high-frequency componentof HR variability which indicates a change from sympatheticactivities to parasympathetic activities

To date there have been no studies that measure theeffects of massage on endothelial inflammatory markers Inthis current study the massage group experienced a signifi-cant reduction of VCAM-1 from an abnormal level to a nor-mal level with a greatermagnitude difference compared to thecontrol groupwhich also showed significant reduction Braunand Simonson 2008 [20] stated that SMT through effleurageand compression increases local blood flow If blood viscosityremains unchanged the increase in blood flow increasesshear stress on the blood vessel wall The increase in shearstress decreases the expression of VCAM-1 [18 37] This

is supported by the studies of Ando et al (1994) [17]Korenaga et al (1997)[38] and Helmlinger et al (1995)[39]which showed decrease in the production of VCAM-1 atphysiological shear stress of gt15 dynecm2 and an increase inthe production of VCAM-1 at shear stress of plusmn0ndash4 dynecm2

It was expected that the level of ICAM-1 of the massagegroup increases after the intervention Walpola et al (1995)[18] showed that high shear stress (305 dynecm2) increasesthe expression of ICAM-1 Nagel et al (1994) [40] whostudied the effects of shear stress at 10 dynecm2 on theexpression of ICAM-1 on human umbilical vein endothelialcells (HUVEC) and Morigi et al (1995) [10] who exposedHUVEC at shear stress of 8 dynecm2 also reported anincrease in the expression of ICAM-1 However the currentstudy showed no significant changes in both massage andcontrol groups for ICAM-1 It may be that the shear stresscreated by massage is not large enough to have effects onICAM-1 Further studies are warranted on the effects ofmassage on blood flow to confirm the effects discussed above

5 Conclusion

This study has shown that Swedish Massage Therapy or rest-ing an hourweekly significantly reduced BPHR andVCAM-1 through the effects that have been discussed However theeffect of rest on BP does not extend to fourweeks as comparedto SMT In addition massage also reduces resting HR inhypertensive women

Acknowledgments

The authors would like to acknowledge all the staff atthe Physiology Department Cardiology Unit Clinical TrialWard and the Centre for Research in Emergency MedicineUKMMC for all their support during this research Thisresearch was funded by UKMMC Fundamental ResearchGrant (FF-280-2009)

References

[1] L Rampal S Rampal M Z Azhar and A R RahmanldquoPrevalence awareness treatment and control of hypertensionin Malaysia a national study of 16440 subjectsrdquo Public Healthvol 122 no 1 pp 11ndash18 2008

[2] T O Lim Z Morad R H Hussein et al ldquoPrevalence aware-ness treatment and control of hypertension in the Malaysianadult population results from the National Health andMorbid-ity Survey 1996rdquo Singapore Medical Journal vol 45 no 1 pp20ndash27 2004

[3] National Health amp Morbidity Survey III (NHMS III) Confer-ence Proceedings Putrajaya Malaysia November 2007

[4] MOHPPAK17108(GU) Clinical Practice Guidelines Preven-tion of Cardiovascular Disease inWomen Academy ofMedicineof Malaysia Kuala Lumpur Malaysia 1st edition 2008

[5] D Sanz-Rosa M P Oubina E Cediel et al ldquoEffect of AT1receptor antagonism on vascular and circulating inflammatorymediators in SHR role of NF-120581BI120581B systemrdquoAmerican Journalof Physiology vol 288 no 1 pp H111ndashH115 2005

[6] Q Capers IV R W Alexander P Lou et al ldquoMonocytechemoattractant protein-1 expression in aortic tissues of hyper-tensive ratsrdquo Hypertension vol 30 no 6 pp 1397ndash1402 1997


[7] G Luvara M E Pueyo M Philippe et al ldquoChronic blockadeof NO synthase activity induces a proinflammatory phenotypein the arterial wall prevention by angiotensin II antagonismrdquoArteriosclerosis Thrombosis and Vascular Biology vol 18 no 9pp 1408ndash1416 1998

[8] A J H Gearing and W Newman ldquoCirculating adhesion mole-cules in diseaserdquo Immunology Today vol 14 no 10 pp 506ndash5121993

[9] J Constans and C Conri ldquoCirculating markers of endothelialfunction in cardiovascular diseaserdquo Clinica Chimica Acta vol368 no 1-2 pp 33ndash47 2006

[10] M Morigi C Zoja M Figliuzzi et al ldquoFluid shear stress mod-ulates surface expression of adhesion molecules by endothelialcellsrdquo Blood vol 85 no 7 pp 1696ndash1703 1995

[11] A Gnasso C Irace C Carallo et al ldquoIn vivo associationbetween low wall shear stress and plaque in subjects withasymmetrical carotid atherosclerosisrdquo Stroke vol 28 no 5 pp993ndash998 1997

[12] O Traub and B C Berk ldquoLaminar shear stress mechanismsby which endothelial cells transduce an atheroprotective forcerdquoArteriosclerosis Thrombosis and Vascular Biology vol 18 no 5pp 677ndash685 1998

[13] D N Ku D P Giddens C K Zarins and S Glagov ldquoPulsatileflow and atherosclerosis in the human carotid bifurcation Posi-tive correlation between plaque location and low and oscillatingshear stressrdquo Arteriosclerosis vol 5 no 3 pp 293ndash302 1985

[14] J Ravensbergen J W Ravensbergen J K B Krijger B Hillenand H W Hoogstraten ldquoLocalizing role of hemodynamicsin atherosclerosis in several human vertebrobasilar junctiongeometriesrdquo Arteriosclerosis Thrombosis and Vascular Biologyvol 18 no 5 pp 708ndash716 1998

[15] C K Zarins D P Giddens and B K Bharadvaj ldquoCarotidbifurcation atherosclerosis Quantitative correlation of plaquelocalization with flow velocity profiles and wall shear stressrdquoCirculation Research vol 53 no 4 pp 502ndash514 1983

[16] O A Paniagua M B Bryant and J A Panza ldquoRole of endothe-lial nitric oxide in shear stress-induced vasodilation of humanmicrovasculature diminished activity in hypertensive andhypercholesterolemic patientsrdquo Circulation vol 103 no 13 pp1752ndash1758 2001

[17] J Ando H Tsuboi R Korenaga et al ldquoShear stress inhibitsadhesion of cultured mouse endothelial cells to lymphocytesby downregulating VCAM-1 expressionrdquo American Journal ofPhysiology vol 267 no 3 pp C679ndashC687 1994

[18] P L Walpola A I Gotlieb M I Cybulsky and B L LangilleldquoExpression of ICAM-1 and VCAM-1 and monocyte adherencein arteries exposed to altered shear stressrdquo ArteriosclerosisThrombosis and Vascular Biology vol 15 no 1 pp 2ndash10 1995

[19] S Fritz Mosbyrsquos Fundamentals of Therapeutic Massage MosbyElsevier St Louis Mo USA 2009

[20] M B Braun and S J Simonson Introduction to Massage Ther-apy LippincottWilliams ampWilkins Philadelphia Pa USA 2ndedition 2008

[21] E Ernst ldquoThe safety ofmassage therapyrdquoRheumatology vol 42no 9 pp 1101ndash1106 2003

[22] Y Ouchi T Kanno H Okada et al ldquoChanges in cerebral bloodflow under the prone condition with and without massagerdquoNeuroscience Letters vol 407 no 2 pp 131ndash135 2006

[23] K C Richards R Gibson and A L Overton-McCoy ldquoEffectsof massage in acute and critical carerdquo AACN Clinical Issues vol11 no 1 pp 77ndash96 2000

[24] A Moraska R A Pollini K Boulanger M Z Brooks and LTeitlebaum ldquoPhysiological adjustments to stress measures fol-lowing massage therapy a review of the literaturerdquo Evidence-Based Complementary andAlternativeMedicine vol 7 no 4 pp409ndash418 2010

[25] C M Olney ldquoThe effect of therapeutic back massage in hyper-tensive persons a preliminary studyrdquo Biological Research forNursing vol 7 no 2 pp 98ndash105 2005

[26] M Hernandez-Reif T Field J Krasnegor Z Hossain HTheakston and I Burman ldquoHigh blood pressure and associatedsymptoms were reduced by massage therapyrdquo Journal of Body-work and Movement Therapies vol 4 no 1 pp 31ndash38 2000

[27] M Moeini M Givi Z Ghasempour and M Sadeghi ldquoTheeffect of massage therapy on blood pressure of women with pre-hypertensionrdquo Iranian Journal of NursingampMidwifery Researchvol 16 no 1 pp 61ndash70 2011

[28] I G P Duimel-Peeters R J GHalfensM P F Berger and LHE H Snoeckx ldquoThe effects of massage as a method to preventpressure ulcers A review of the literaturerdquo OstomyWoundManagement vol 51 no 4 pp 70ndash80 2005

[29] Y H Chan ldquoRandomised controlled trials (RCTS)mdashsamplesize themagic numberrdquo SingaporeMedical Journal vol 44 no4 pp 172ndash174 2003

[30] J M Lovas A R Craig Y D Segal R L Raison K MWeston and M R Markus ldquoThe effects of massage therapyon the human immune response in healthy adultsrdquo Journal ofBodywork and Movement Therapies vol 6 no 3 pp 143ndash1502002

[31] M Aourell M Skoog and J Carleson ldquoEffects of Swedish mas-sage on blood pressurerdquo Complementary Therapies in ClinicalPractice vol 11 no 4 pp 242ndash246 2005

[32] A Billhult C Lindholm R Gunnarsson and E Stener-Victorin ldquoThe effect of massage on immune function and stressin women with breast cancermdasha randomized controlled trialrdquoAutonomic Neuroscience Basic and Clinical vol 150 no 1-2 pp111ndash115 2009

[33] S S Meek ldquoEffects of slow stroke back massage on relaxationin hospice clientsrdquo Journal of Nursing Scholarship vol 25 no 1pp 17ndash21 1993

[34] S P Lawler and L D Cameron ldquoA randomized controlledtrial of massage therapy as a treatment for migrainerdquo Annals ofBehavioral Medicine vol 32 no 1 pp 50ndash59 2006

[35] J A Hayes and C Cox ldquoImmediate effects of a five-minute footmassage on patients in critical carerdquo Complementary Therapiesin Nursing amp Midwifery vol 6 no 1 pp 9ndash13 2000

[36] M A Diego and T Field ldquoModerate pressure massage elicits aparasympathetic nervous system responserdquo International Jour-nal of Neuroscience vol 119 no 5 pp 630ndash638 2009

[37] P L Walpola A I Gotlieb and B L Langille ldquoMonocyteadhesion and changes in endothelial cell number morphologyand F-actin distribution elicited by low shear stress in vivordquoAmerican Journal of Pathology vol 142 no 5 pp 1392ndash14001993

[38] E Korenaga J Ando K Kosaki M Isshiki Y Takada and AKamiya ldquoNegative transcriptional regulation of the VCAM-1gene by fluid shear stress in murine endothelial cellsrdquoAmericanJournal of Physiology vol 273 no 5 pp C1506ndashC1515 1997

[39] G Helmlinger B C Berk and R M Nerem ldquoCalciumresponses of endothelial cell monolayers subjected to pulsatileand steady laminar flow differrdquo American Journal of Physiologyvol 269 no 2 pp C367ndashC375 1995


[40] T Nagel N Resnick W J Atkinson C F Dewey Jr and M AGimbrone Jr ldquoShear stress selectively upregulates intercellularadhesion molecule-1 expression in cultured human vascularendothelial cellsrdquo Journal of Clinical Investigation vol 94 no2 pp 885ndash889 1994

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014


MEDIATORSINFLAMMATION

of


Behavioural Neurology

EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of



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OphthalmologyJournal of


Diabetes ResearchJournal of



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Gastroenterology Research and Practice


Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom


tractive forces or shear stress induced by the blood flow veloc-ity gradient near the vessel wall [10]

Shear stress is defined as the tangential drag force of bloodpassing along the surface of the endothelium [11] Shear stressis directly proportional to blood viscosity and velocity andinversely proportional to blood vessel diameter (shear stress =blood viscosity times blood velocityvessel diameter) There aretwo types of shear stress the atheroprotective laminar orpulsatile shear stress which occurs in straight blood vessels[12] and the atherogenic oscillatory shear stress which occursat bends and bifurcation of arteries [13ndash15]The physiologicalatheroprotective shear stress is more than 15 dynecm2 In theevent of narrowing of the arteries the shear stress here is lowConsequently blood will rush out of the narrow opening athigh velocity and create a higher shear stress on the arterialwall therefore inducing endothelial-dependent nitric oxide-mediated vasodilation which brings the shear stress back tonormal However this effect is blunted in hypertensive andhypercholesterolemic patients [16] It was found that withincreasing shear stress the expression of VCAM-1 is lowand the expression of ICAM-1 is high There was also noleukocytes adhesion to the vessel wall In contrast if there is adecrease in shear stress the expression of VCAM-1 increasesand the expression of ICAM-1 decreases with leukocytesadhesion to the vessel wallThis is indicative of the early stageof development of atherosclerosis [17 18]

Swedish Massage Therapy (SMT) is a complementarytreatment that is believed to provide relaxation and thereforeable to reduce blood pressure caused by stress [19] It is themost recognised and frequent usedmassage therapy [20] It ischaracterised by long strokes applied according to the venousand lymphatic flow It is a painless gentle and nonforcefultechnique that is not associated with any serious adverseeffects [21]Massage therapy has been shown to decrease sym-pathetic activity and increase parasympathetic activity [22]Therefore this therapy is able to decrease anxiety and stress[23 24] In addition massage therapy is able to reduce bloodpressure (BP) and heart rate (HR) in hypertensive individuals[25ndash27] It also increases skin blood flow and suppleness andinduces tissue relaxation [28] The long strokes in massagecompress the body tissues and when released increase bloodflow to the local area [19]

The present study assessed the effects of SMT versus reston hypertensive women If SMT yields positive results in thisstudy it can be recommended as an adjunct or a complemen-tary therapy to the conventional management of hyperten-sion especially in women as the prevalence of hypertension inwomen is high [1 2] As far as the authorrsquos present knowledgeextends no studies have assessed the effects of whole bodySwedishMassageTherapy onhypertensivewomenonBPHRand inflammatory markers In view of the literature statedabove it was hypothesized that massage increases blood flowand thus increases shear stress on the blood vessel wall Theincrease in shear stress reduces the expression of VCAM-1and vWF and increases ICAM-1 In addition through theactivation of parasympathetic nervous system massage isable to reduce BP and HR Therefore Swedish Massage Ther-apy is expected to reduce BP HR and VCAM-1 and increaseICAM-1

2 Methods

21 Participants This study is an experimental randomizedcontrol trial that has been approved by the Ethics Commit-tee of the Universiti Kebangsaan Malaysia Medical Centre(UKMMC) (Project Ethics Code FF-280-2009) The par-ticipants were 35ndash60-year-old women recruited from theUKMMC records These women must fulfil the followingcriteria

(a) body mass index (BMI) of less than 35 kgm2(b) SBP of 120ndash159mmHg andDBPof 90ndash99mmHgwith

or without treatment If they are on antihypertensiveor anticholesterol medications they must be on onlyone medication of the same type and dose for at leastsix months

(c) normal liver thyroid and renal functions(d) not taking any prescribed andor traditional medi-

cations (apart from those stated in (b)) and supple-ments

(e) not smoking or drinking alcohol(f) no other illnesses(g) not pregnant(h) have not experienced Swedish Massage Therapy

Detailed explanation of the study was given to eachwoman All women had signed the consent form before par-ticipating in this study

The sample size is calculated based on paired samples thatis BP taken before and after intervention with continuousoutcomesThe formula used in this study is taken from Chan2003 [29]The values for this formula are taken from anotherstudy [26] with a similar topic and significant results Theminimum number of subjects calculated is 16 with 8 subjectsper group

Twenty-three women fulfilled the above criteria andwere screened for any health conditions that may influencetheir blood pressure Blood pressure of these women wasmonitored for two weeks prior to the intervention Bloodsamples were taken to ensure that the liver thyroid and renalfunction and the fasting blood glucose level were normalResting electrocardiogram (ECG) and stress tests were alsocarried out to ensure normal cardiac function Fasting bodycomposition was measured before and after the interventionto ensure that the body fluid distribution remains unchangedTwenty women successfully passed their screening Thesewomen were randomly assigned to two groups the massagegroup and the control group using random numbers gener-ated through the SPSS version 15 software However only 16women (8 per group) successfully completed the interven-tion

22 Intervention In this study the massage protocol is anhour of Swedish Massage Therapy to the whole body once aweek for four weeks An hour of massage allows enough timeto apply all the Swedishmassage techniques to thewhole bodywhich was expected to produce positive effects on BP and













































3 Results






119875








124126128130132134136138140142144


48 hrpost

session4

SBP

(mm

Hg)

Time


143

140

141lowast138

Δ137

Δ134

Δ141

Δ134

Δ138

Δ131

++


747678808284868890


48 hrpost

session4

DBP

(mm

Hg)

Time

87

81

lowast875

lowast885

lowast815

lowast80

lowast80

Δ79

Δ85 Δ

82




4 Discussion


01020304050607080


48 hrspost

Session4

HR

(bpm

)

Time

72

64 lowast60

lowast70

lowast74

lowast

lowast

60

68

695

lowast62

lowast62

715 Δ

70




0

200

400

600

800

1000

1200

1400

1600

1800

2000

Week 0 Week 4Time


19883

V-CA

M 1

(ng

mL)

142055

99025lowast 104485

lowast




0

50

100

150

200

250

300

350

400

450

Week 0 Week 4Time

415

I-CA

M 1

(ng

mL)


365

300

370









5 Conclusion


Acknowledgments


References
















































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of




























































3 Results






119875








124126128130132134136138140142144


48 hrpost

session4

SBP

(mm

Hg)

Time


143

140

141lowast138

Δ137

Δ134

Δ141

Δ134

Δ138

Δ131

++


747678808284868890


48 hrpost

session4

DBP

(mm

Hg)

Time

87

81

lowast875

lowast885

lowast815

lowast80

lowast80

Δ79

Δ85 Δ

82




4 Discussion


01020304050607080


48 hrspost

Session4

HR

(bpm

)

Time

72

64 lowast60

lowast70

lowast74

lowast

lowast

60

68

695

lowast62

lowast62

715 Δ

70




0

200

400

600

800

1000

1200

1400

1600

1800

2000

Week 0 Week 4Time


19883

V-CA

M 1

(ng

mL)

142055

99025lowast 104485

lowast




0

50

100

150

200

250

300

350

400

450

Week 0 Week 4Time

415

I-CA

M 1

(ng

mL)


365

300

370









5 Conclusion


Acknowledgments


References
















































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of




















3 Results






119875








124126128130132134136138140142144


48 hrpost

session4

SBP

(mm

Hg)

Time


143

140

141lowast138

Δ137

Δ134

Δ141

Δ134

Δ138

Δ131

++


747678808284868890


48 hrpost

session4

DBP

(mm

Hg)

Time

87

81

lowast875

lowast885

lowast815

lowast80

lowast80

Δ79

Δ85 Δ

82




4 Discussion


01020304050607080


48 hrspost

Session4

HR

(bpm

)

Time

72

64 lowast60

lowast70

lowast74

lowast

lowast

60

68

695

lowast62

lowast62

715 Δ

70




0

200

400

600

800

1000

1200

1400

1600

1800

2000

Week 0 Week 4Time


19883

V-CA

M 1

(ng

mL)

142055

99025lowast 104485

lowast




0

50

100

150

200

250

300

350

400

450

Week 0 Week 4Time

415

I-CA

M 1

(ng

mL)


365

300

370









5 Conclusion


Acknowledgments


References
















































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















124126128130132134136138140142144


48 hrpost

session4

SBP

(mm

Hg)

Time


143

140

141lowast138

Δ137

Δ134

Δ141

Δ134

Δ138

Δ131

++


747678808284868890


48 hrpost

session4

DBP

(mm

Hg)

Time

87

81

lowast875

lowast885

lowast815

lowast80

lowast80

Δ79

Δ85 Δ

82




4 Discussion


01020304050607080


48 hrspost

Session4

HR

(bpm

)

Time

72

64 lowast60

lowast70

lowast74

lowast

lowast

60

68

695

lowast62

lowast62

715 Δ

70




0

200

400

600

800

1000

1200

1400

1600

1800

2000

Week 0 Week 4Time


19883

V-CA

M 1

(ng

mL)

142055

99025lowast 104485

lowast




0

50

100

150

200

250

300

350

400

450

Week 0 Week 4Time

415

I-CA

M 1

(ng

mL)


365

300

370









5 Conclusion


Acknowledgments


References
















































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















0

50

100

150

200

250

300

350

400

450

Week 0 Week 4Time

415

I-CA

M 1

(ng

mL)


365

300

370









5 Conclusion


Acknowledgments


References
















































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

























































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of





















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















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Research Article Effects of Swedish Massage Therapy on Blood …downloads.hindawi.com/journals/ecam/2013/171852.pdf · 2019. 7. 31. · Effects of Swedish Massage Therapy on Blood