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Cardiorespiratory effect of Swedish technique back massage inhypertensive patients: A Randomized Clinical Trial

Authors: Mehdi Moghadasi, Zinat Mohebbi, Kaynoosh Homayouni, MohammadHossein Nikoo

DOI: 10.5603/AH.a2021.0026

Article type: Original paper

Submitted: 2021-06-29

Accepted: 2021-08-04

Published online: 2021-10-14

This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely,

provided the work is properly cited.The final version may contain major or minor changes.

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Cardiorespiratory effect of Swedish technique back massage in hypertensive patients: a

randomized clinical trial

Running title: Cardiorespiratory effect back massage in hypertensive patients

10.5603/AH.a2021.0026

Mehdi Moghadasi1, Zinat Mohebbi1, Kaynoosh Homayouni2, Mohammad Hossein Nikoo2

1Department of Nursing, School of Nursing, Shiraz University of Medical Sciences, Shiraz,

Iran3University of Medical Sciences, Shiraz, Iran

Corresponding author: Zinat Mohebbi, Ph.D., Assistant Professor in Nursing, Department

of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz,

71936-13119, Iran, tel:+987136474254; fax:+987136474252; e-mail:

Zinat.Mohebbi54@yandex.com

Abstract

Background: Stress is one of the main factors leading to z hypertension. Behavioral

methodologies, such as unwinding and rub, have a dramatic effect on controlling the

individuals’ reaction to stress, diminishing hypertension and heart rate, as well as changing

temperature and respiration rate.

Material and methods: This non-blind clinical trial was performed on 90 patients with

primary excessive blood stress. The patients have been haphazardly classified into an affect

ANd an intervention cluster. In the two groups, vital signs (systolic and diastolic blood

pressure, Heart rate, Temperature and Respiratory) were measured and recorded two times a

week before and after a ten-min Swedish- back massage and relaxation for six weeks . The

records have been accrued using a questionnaire which includes demographic records, a

checklist of Vital signs (systolic and diastolic blood pressure, heart rate, temperature, and

respiratory) record, a fixed manometer and thermometer.

Results: Within the experimental group, systolic and diastolic blood pressure, heart rate, and

respiratory levels reduced to 6.44 and 4.77 mm Hg, 2.9 Bpm, 0.94 breaths per minute,

respectively (p < 0.001) and temperature increased to 0.08 ° C after the back massage (P =

0.004).

Conclusion: The obtained results show the effectiveness of back massage in reducing blood

pressure, heart rate, and respiratory as well as increased temperature in the study participants.

Key words: cardiorespiratory; back massage; hypertension

Introduction

Seventh Joint National Committee on Prevention, Detection, assessment, and treatment of

excessive Blood pressure (JNC7), Blood pressure (BP) is taken into consideration excessive

if it exceeds 140/90 mm Hg . High blood pressure is one of the leading causes of the rise in

cardiovascular illnesses. In 2018, nearly half a million deaths in the United States are caused

by hypertension which is a primary or contributing cause . Nearly half of adults in the United

States (108 million, or 45%) have hypertension with systolic blood pressure (≥ 130 mm Hg)

or a diastolic blood pressure ( ≥ 80 mm Hg) or take medication for hypertension . High blood

pressure is the foremost imperative chance figure for cardiovascular and inveterate renal

disappointment illnesses and burdens expenses on both people and social orders . High blood

pressure costs the United States about 131 billion USD each year, on average, over 12 years

from 2003 to 2014 . In Iran, HTN level is 20.1% (10.3% systolic HTN and 6.9% diastolic

HTN) . The advantages of doing massage include mitigation of stress and tensions, relief of

Mental and physical fatigue, improvement of circulation , healing headache and eyestrain,

traumatized muscle tissue . Furthermore, Osborn et al. stated that complementary medicine

could decrease BP, and this technique turned into smooth, to be had, and more affordable than

medications . Considering the physiopathology of blood pressure and the successful

component of massage treatment, unwinding massage can encourage the reaction of the

parasympathetic nerve. Thus , leading to regulating blood pressure, heart rate and anxiety .

Systolic BP increments amid intense stretch, whereas diastolic BP increments as it were after

long-term stretch. Diastolic BP decreases over time can be due to persistent tactile

incitement . In a few studies, the sample volume was small while in others, only girls or guys

with hypertension had been tested. According to a study , the systematic review quality

assessment tool was a poor method for doing massage . In a few other studies, the variety of

massage periods were short. Further, some studies have been done on parameters such as

vital signs. Thus, the current work eliminated the gaps in prior researched. The aim of the

present study was to examine the effect of back massage, as a non-pharmacological method,

on vital signs in sufferers with number one high blood pressure.

Material and methods

In this clinical trial, all the subjects who referred to a defined clinic (Imam Reza) affiliated

with the Shiraz University of Medical Sciences for blood pressure check up in a 79-day

period from August to September 2013 were considered. Ethical approval was obtained from

the local Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.

1392.S6603). Eligible participants were informed about the study objective, and the voluntary

nature of their participation. Written informed consent form was filled out by all the

participants. The data were collected anonymously without name lists. Those diagnosed with

primary hypertension were included according to the following criteria: age of 30–70 years

old, absence of psychological diseases, no participation in other relaxation programs, without

history of hypotension, skin disorders and backbone, receiving no anti-anxiety and sedative

drugs, with at least six months of diagnosis with primary hypertension, adherence to

medication regimen during the study, systolic blood pressure of 130/170 mm Hg and diastolic

blood pressure of 80/120 mm Hg, without diabetes and related disorders that lead to

hypertension such as renal diseases, suprarenal tumors, and congenital heart deficits. Signing

an informed consent is obligatory to enter the study. Exclusion criteria were defined as back

pain because of backbone injuries, hernia or disk degeneration, and patients who experienced

lumbar surgery. The study sample size was determined based on the study by Hassanvand et

al. entitled “The effect of back massage on BP and radial heart rate of patients with primary

hypertension” and using the following formula (d = 10, S = 8, α = 0.05, β = 0.2).

n = (Z 1-α/2 + Z 1-β)2 × 2S2

d2

n = (1.96 + 0.84)22 × 64 n = 40

100

The samples were selected through convenience sampling. At first, the patients under study,

filled out the demographic information questionnaire and the written informed consent. A

total of 80 patients participated in the study and were randomly divided into an intervention

and a control group, each containing 40 patients. Moreover, 5 patients were added to each

group because of the attrition; thus, each group consisted of 45 patients.

To measure BP, heart rate and temperature in this study, a digital manometer and thermometer

were used (Digital manometer: Onyx model, the Measurement accuracy of BP = ± 3mm Hg,

Measurement accuracy heart rate = ± 5%, Digital thermometer: Truly model, the

Measurement accuracy of temperature = ± 0.2) whose reliability and validity have been

confirmed previously. It was calibrated at the onset and middle of the study and used by the

researcher unaware of which sample is allocated to each group. Pearson’s correlation

coefficients for the reliability of systolic and diastolic BPs, heart rate and temperature were

0.97, 0.95, 0.96 and 0.94, respectively . Respiratory rate was assessed through the

observation. A total of 90 patients were randomly assigned to experimental and control

groups.

Description of the procedure

A man and a woman massager were trained the methods by a physical medicine expert. The

expert supervised the performance of the massagers to assure about the uniformity of the

procedure. Furthermore, two nurses were employed to fill the forms after the massage

procedure and rest in the experimental and control groups, respectively. The massage that was

applied in the present study is a part of Swedish massage which starts from neck to the back

(from shoulders to lumber area) via compression or kneading and continues with pushing,

tapotement, and ringing. The study was done for two days per week from 8 A.M. to 13 P.M.

for six weeks. A demographic questionnaire and check list of BP, heart rate, temperature and

respiratory rate records was filled for all the participants. In both groups, participants were

asked to have a five-minute rest upon arrival and then, their. BP, heart rate, temperature and

respiratory rate were recorded twice a week for 6 weeks before every intervention. In the

experimental arm, sesame oil was used for 10-minute massage. Immediately after the 10-min

massage, BP, heart rate, temperature and respiratory were recorded again. In the control

group, the patients rested for 10 min and BP, heart rate, temperature and respiratory were

recorded then. The study data were collected using a questionnaire including demographic

information, a checklist of BP and heart rate records.

Statistical calculations

Statistical analyses were performed using SPSS (Ver. 15). T test and chi square test were

applied to analyze demographic data. Variables are presented as mean ± SD. Repeated

measures ANOVA was used as appropriate. The significance level was set at p value of <

0.05.

Results

Both the experimental arm and the control arm constituted 45 patients with 25 females in the

former and 27 females in the latter. Because four females did not continue their participation,

41 patients were considered in the control group. The mean age of the participants was 57.98

± SD with dominance of female. Demographic variables including age, gender, educational

degree, marital status, and occupation were not significantly different between the

experimental and the control groups (Tab. 1).

.

Table 1. The patients’ demographic data

Variable

Experimental Control Total Used test and p-

value

)intervention

group vs. control

group(Age (mean ± SD) 56.80 ± 8.16 59.17 ± 8.5 57.98 t- test

p = 0.18Sex Male 20 18 38 Chi-square

p = 0.67Female 25 27 52

Education

level

Above diploma 7 3 10

Chi-square

p = 0.48

Diploma 13 11 24Below diploma 20 24 44Illiterate 5 7 12

Occupation Employee 3 1 4

Chi-square

p = 0.76

Self-employed 5 5 10

Retired 11 13 24

Housewife 26 26 52Marital

status

Widowed 2 4 6

Chi-square

p = 0.43

Single 1 0 1

Married 42 41 83

The statistical results applied from the change in the mean variables are depict in Table 2. In

the experimental group, the systolic BP mean declined to 6.44 mm Hg and there was

statistically significant difference; the diastolic BP mean declined to 4.77 mm Hg and there

was statistically significant difference; the mean of heart rate decreased to 2.9 Bpm and the

difference was statistically significant; the mean of respiratory decreased to 0.94 breaths per

minute and the difference was statistically significant, the mean of temperature raised to 0.08

° C and the difference was statistically significant. In the control group, the mean of systolic

BP declined to 2.31 mm Hg, but it was not statistically significant difference; the mean of

diastolic BP declined to 1.5 mm Hg, and it was not statistically significant difference; the

mean of heart rate declined to 0.98 Bpm in the control group, but the difference was

statistically significant; the mean respiratory decreased to 0.09 breaths per minute, but the

difference was not statistically significant; the mean temperature declined to 0.03 ° C, but the

difference was not statistically significant.

Table 2. The results of the mean variables change. Repeated measures ANOVA

.

Variables Group F p-value

Systolic blood pressure Experimental 11.39 < 0.001

Control 2.29 0.052

Diastolic blood

pressure

Experimental 7.36 < 0.001

Control 1.2 0.23

Heart rate Experimental 5.35 < 0.001

Control 5.69 < 0.001

Respiratory Experimental 4.73 < 0.001

Control 0.69 0.862

Temperature Experimental 1.95 0.004

Control 0.76 0.785

The changes in systolic and diastolic BP, heart rate, temperature and respiratory were

compared between the experimental and the control arm from sessions 1–12, and the results

of repeated measures ANOVA indicated that the differences were statistically significant (P <

0.001, p < 0.001, p = 0.008, p = 0.04, p = 0.04). Furthermore, the effect of time, group, and

time*group on systolic, diastolic BP and heart rate in both groups were assessed using

repeated-measures ANOVA, and the results is showed in Table 3. According to the specialist

cardiologists’ comments, a decline in systolic and diastolic BP and heart rate was clinically

significant only in the experimental group.

Table 3. The effect of time, group, and time*group on systolic and diastolic blood pressure,

heart rate, temperature and respiratory

p-valueFDfBlood

pressure

Effect

>0.0018.924SystolicTime

>0.0014.8124Diastolic >0.0019.1724Heart rate

0.251.1624Temperature

>0.0013.4424Respiratory

0.00210.771SystolicGroup

0.025.341Diastolic0.016.821Heart rate

0.152.041Temperature

0.053.931Respiratory

>0.0013.9624SystolicTime*Group

>0.0012.7724Diastolic

0.0081.8424Heart rate

0.041.5224Temperature

0.041.5324Respiratory

Discussion

The consequences demonstrated a decrease in the mean of systolic and diastolic BP, heart

rate, and respiratory after the intervention. Moreover, the patients’ means of temperature

increased in the intervention group and means of temperature reduced within the control

bunch. In this way, the comes about demonstrated the viability of massage in controlling BP

and heart rate. Similarly , a study in Hong Kong showed that a 10-minute massage for 7

consecutive days by superficial stroke technique become effective in decreasing high blood

pressure inside the aged individuals with stroke . A comparative ponder explored the impacts

of Swedish massage on BP, heart rate, and fiery markers in ladies with hypertension. In that

think about, the members were partitioned into an intercession (n = 8) and a control (n = 8)

groups. The comes about uncovered a critical diminishment in systolic and diastolic BP and

heart rate after the fourth session . Reliably, another research suggested a decrease in systolic,

diastolic BPs and heart rate after a 10- session back knead. The individuals served both as the

experimental and the control group , while in the present study, in the third session of

massage for the second group, systolic blood pressure increased slightly while several studies

indicate a decrease in systolic blood pressure after the massage. Since this group had received

LAF massage first, this slight increase in systolic blood pressure results in a reflex ,

increasing systolic blood pressure due to not having the history of blood pressure reduction

regarding parasympathetic nerve roots which can be stimulated during BNC massage . In

another study in Carolina, the effect of massage on mental and physical symptoms of

rehabilitation patients by superficial stroke method was evaluated. The outcomes of that work

showed a significant decrease in BP and heart rate after the intervention . However, another

study on massage showed no significant changes in systolic and diastolic BP . Nonetheless,

the outcomes of several researches revealed that massage therapy reduced diastolic and

systolic BP considerably . In a study conducted in 2011, a decrease in heart rate in the

intervention group was not statistically significant, but a decrease in heart rate in the control

group was statistically significant . In one of the studies, increases in temperature after the

massage were statistically significant , decreased respiratory rate was statistically significant

and temperature changes were not statistically significant , the mean of systolic and

diastolic blood pressure was significantly different, and the heart rate was significantly

different before and after foot massage in the experimental group; while in the control group,

there were no significant differences between the mean of systolic and diastolic blood

pressure, and heart rates [27]. Jahdi, Mehrabadi et al, showed that mother's vital signs during

postpartum period reduced significantly after the massage compared to the control group .

The results of the studies showed that massage therapy reduces systolic blood pressure,

respiratory rate, and heart rate in patients . This indicates the impact of this non-

pharmacological treatment strategy on lessening BP in old individuals with hypertension.

One of the restrictions of the present research was that back massage on the previously

mentioned regions done only 10 minutes. Therefore, assist studies are suggested to apply

massages on the entire body and for a longer period. However, the recurrence of massage

sessions and the number of members were the solid focuses of the show consider.

Conclusion

The results of the present study showed that a 12-session back massage decreased systolic

and diastolic blood pressure, heart rate, and respiratory and amplified the temperature in

hypertensive patients. Hence, after conducting more researches on this issue, back massage

can be suggested as a non-pharmacological strategy for BP control and lessening heart rate.

Acknowledgments

The show paper was extricated from the proposal composed by Mr. Mehdi Moghadasi and

was monetarily bolstered by Shiraz College of Restorative Sciences (allow No: 92-6603).

The creators would like to recognize all the patients who taken an interest in this consider.

Trial Registration Number: IRCT2013112615552N1.

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