Six weeks of massage therapy produces changes in balance, neurological and cardiovascular measures in older persons

Joellen M Sefton, Ceren Yarar, Jack W Berry, Joellen M Sefton, Ceren Yarar, Jack W Berry

Abstract

Objectives: Falls in older adults represent a primary cause of decreased mobility and independence, increased morbidity, and accidental death. Research and clinical reports indicate that therapeutic massage (TM) may positively influence suggested causative factors. The second in a two-part study, this project assessed the effects of six weeks of TM treatment on balance, nervous system, and cardiovascular measures in older adults.

Design: A randomized controlled trial assessed the effects of six weekly 60-minute sessions of TM on balance, cardiovascular, and nervous system measures. Thirty-five volunteers (19 male and 16 female; ages 62.9 ± 4.6) were randomly assigned to relaxation control or TM groups. A 2 × 4 [treatment condition X time (week 1 and 6)] mixed factorial experimental design was utilized for cardiovascular/balance variables assessed at pretreatment baseline, immediate post-treatment, and 20- and 60-minutes post-treatment; nervous system measures were assessed only at pretreatment and at 60-minute follow-up (2 × 2 mixed design). Long-term benefits were assessed by comparing the TM and control groups on pretreatment baseline measures at week six and a follow-up assessment at week seven (2 × 3 mixed design).

Setting: Laboratory

Intervention: Six weekly 60-minute, full-body TM.

Outcome measures: Postural control/cardiovascular measures were assessed weeks one, six, and seven; pretreatment and immediate, 20- and 60-minutes post-treatment. Motoneuron pool excitability was assessed pretreatment and 60 minutes post-treatment.

Results: The TM group showed significant differences relative to controls in cardiovascular and displacement area/velocity after the week six session, with decreasing blood pressure and increasing stability over time from immediate post-TM to 60 minutes post-TM. The TM group revealed lower H-max/M-max ratios 60-minutes post-treatment. Long-term differences between the groups were detected at week seven in displacement area/velocity and systolic blood pressure.

Conclusions: Results suggest six weeks of TM resulted in immediate and long-term improvements in postural stability and blood pressure, compared to a controlled condition.

Keywords: blood pressure; falls; heart rate; postural control; sensorimotor.

Figures

Figure 1
Figure 1
Diagram of study design and data collection time points.
Figure 2
Figure 2
Double- and single-legged stance. (a) A double-leg stance for the static balance test and H-reflex testing was assumed with two feet placed shoulder width apart and with hands on the hips. (b) A single-leg stance for the functional balance test and H-reflex testing was assumed with the non-stance extremity standardized in a position of 30 degrees of hip flexion and 90 degrees of knee flexion, with the ankle relaxed.
Figure 3
Figure 3
Short term post-treatment postural control displacement (a),velocity (b), and systolic blood pressure (c) trajectories at week 6 (measure across time: 0, 20 and 60 min time points). Post = measures taken immediately after the TM session; 20 = 20 minutes after TM session; 60 = 60 minutes after TM; EODL = eyes-open double-leg; ECDL = eyes-closed double-leg; solid line = treatment group; dashed line = control group.

References

    1. Vellas BJ, Wayne SJ, Romero LJ, et al. Fear of falling and restriction of mobility in elderly fallers. Age Ageing. 1997;26(3):189–193. doi: 10.1093/ageing/26.3.189.
    1. Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. J Forensic Sci. 1996;41(5):733–746.
    1. Blank WA, Freiberger E, Siegrist M, et al. interdisciplinary intervention to prevent falls in community-dwelling elderly persons: protocol of a cluster-randomized trial [PreFalls] BMC Geriatr. 2011;11:7. doi: 10.1186/1471-2318-11-7.
    1. Dejaeger E. Falls in the elderly. A need for a general intervention [in Dutch] Tijdschr Gerontol Geriatr. 2005;36(4):136–137.
    1. Faddis MN, Rich MW. Pacing interventions for falls and syncope in the elderly. Clin Geriatr Med. 2002;18(2):279–294. doi: 10.1016/S0749-0690(02)00010-1.
    1. Gillespie LD, Gillespie WJ, Robertson MC, et al. Interventions for preventing falls in the elderly. Cochrane Database Syst Rev. 2003;(4) doi: 10.1002/14651858.CD000340. Art.Nb.CD000340.
    1. Gu MO, Jeon MY, Kim HJ, et al. A review of exercise interventions for fall prevention in the elderly [in Korean] Taehan Kanho Hakhoe Chi. 2005;35(6):1101–1112.
    1. Hendriks MR, van Haastregt JC, Diederiks JP, et al. Effectiveness and cost-effectiveness of a multidisciplinary intervention programme to prevent new falls and functional decline among elderly persons at risk: design of a replicated randomised controlled trial [ISRCTN64716113] BMC Public Health. 2005;5:6. doi: 10.1186/1471-2458-5-6.
    1. Larsson L, Ramamurthy B. Aging-related changes in skeletal muscle. Mechanisms and interventions. Drugs Aging. 2000;17(4):303–316. doi: 10.2165/00002512-200017040-00006.
    1. Neyens JC, van Haastregt JC, Dijcks BP, et al. Effectiveness and implementation aspects of interventions for preventing falls in elderly people in long-term care facilities: a systematic review of RCTs. J Am Med Dir Assoc. 2011;12(6):410–425. doi: 10.1016/j.jamda.2010.07.018.
    1. Nikolaus T, Bach M. Preventing falls in community-dwelling frail older people using a home intervention team (HIT): results from the randomized Falls-HIT trial. J Am Geriatr Soc. 2003;51(3):300–305. doi: 10.1046/j.1532-5415.2003.51102.x.
    1. Zhang JG, Ishikawa-Takata K, Yamazaki H, et al. The effects of Tai Chi Chuan on physiological function and fear of falling in the less robust elderly: an intervention study for preventing falls. Arch Gerontol Geriatr. 2006;42(2):107–116. doi: 10.1016/j.archger.2005.06.007.
    1. Harwood RH, Foss AJ, Osborn F, et al. Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Br J Ophthalmol. 2005;89(1):53–59. doi: 10.1136/bjo.2004.049478.
    1. Johnson CB. Falls in the elderly. San Francisco, CA: UCSF; 2001. UCSF Division of Geriatrics Primary Lecture Series. PowerPoint presentation available from: .
    1. Patel JC. Falls in elderly. Indian J Med Sci. 2000;54(8):350–352.
    1. The prevention of falls in later life. A report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. Dan Med Bull. 1987;34(Suppl 4):1–24.
    1. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701–1707. doi: 10.1056/NEJM198812293192604.
    1. Davies AJ, Kenny RA. Falls presenting to the accident and emergency department: types of presentation and risk factor profile. Age Ageing. 1996;25(5):362–366. doi: 10.1093/ageing/25.5.362.
    1. Richardson JK, Ashton-Miller JA. Peripheral neuropathy: an often-overlooked cause of falls in the elderly. Postgrad Med. 1996;99(6):161–172.
    1. Wolfson LI, Whipple R, Amerman P, et al. Gait and balance in the elderly. Two functional capacities that link sensory and motor ability to falls. Clin Geriatr Med. 1985;1(3):649–659.
    1. Allain H, Bentue-Ferrer D, Polard E, et al. Postural instability and consequent falls and hip fractures associated with use of hypnotics in the elderly: a comparative review. Drugs Aging. 2005;22(9):749–765. doi: 10.2165/00002512-200522090-00004.
    1. Allcock LM, O’Shea D. Diagnostic yield and development of a neurocardiovascular investigation unit for older adults in a district hospital. J Gerontol A Biol Sci Med Sci. 2000;55(8):M458–M462. doi: 10.1093/gerona/55.8.M458.
    1. Hass CJ, Waddell DE, Wolf SL, et al. Gait initiation in older adults with postural instability. Clin Biomech (Bristol, Avon) 2008;23(6):743–753. doi: 10.1016/j.clinbiomech.2008.02.012.
    1. Laughton CA, Slavin M, Katdare K, et al. Aging, muscle activity, and balance control: physiologic changes associated with balance impairment. Gait Posture. 2003;18(2):101–108. doi: 10.1016/S0966-6362(02)00200-X.
    1. Silsupadol P, Lugade V, Shumway-Cook A, et al. Training-related changes in dual-task walking performance of elderly persons with balance impairment: a double-blind, randomized controlled trial. Gait Posture. 2009;29(4):634–639. doi: 10.1016/j.gaitpost.2009.01.006.
    1. Gu MO, Jeon MY, Eun Y. The development & effect of a tailored fall prevention exercise for older adults [in Korean] Taehan Kanho Hakhoe Chi. 2006;36(2):341–352.
    1. Duval C, Lafontaine D, Hebert J, et al. The effect of Trager therapy on the level of evoked stretch responses in patients with Parkinson’s disease and rigidity. J Manipulative Physiol Ther. 2002;25(7):455–464. doi: 10.1067/mmt.2002.126469.
    1. Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull. 2004;130(1):3–18. doi: 10.1037/0033-2909.130.1.3.
    1. Durkin JL, Harvey A, Hughson RL, et al. The effects of lumbar massage on muscle fatigue, muscle oxygenation, low back discomfort, and driver performance during prolonged driving. Ergonomics. 2006;49(1):28–44. doi: 10.1080/00140130500356882.
    1. Sefton JM, Yarar C, Berry JW, et al. Therapeutic massage of the neck and shoulders produces changes in peripheral blood flow when assessed with dynamic infrared thermography. J Altern Complement Med. 2010;16(7):723–732. doi: 10.1089/acm.2009.0441.
    1. Sefton JM, Yarar C, Pasco DD. Effect of therapeutic massage on peripheral blood flow as assessed by skin temperature measures in the neck and shoulders. J Altern Complement Med. 2010;16(7):723–32. doi: 10.1089/acm.2009.0441.
    1. Sefton JM, Yarar C, Carpenter Dm, et al. Physiological and clinical changes after therapeutic massage of the neck and shoulders. Manual Ther. 2011;16(5):487–94. doi: 10.1016/j.math.2011.04.002.
    1. Hedeker D, Gibbons R, Waternaux C. Sample size estimation for longitudinal designs with attrition: comparing time-related contrasts between two groups. J Edu Behav Stats. 1999;24(1):70–93.
    1. Sefton JM, Yarar C, Berry JW. Massage therapy produces short term improvements in balance, neurological and cardiovascular measures in older persons. Int J Ther Mass Bodywork. 2012. In press.
    1. Sefton JM, Yarar C, Hicks-Little CA, et al. Six weeks of balance training improves sensorimotor function in individuals with chronic ankle instability. J Orthop Sports Phys Ther. 2011;41(2):81–89.
    1. Sefton JM, Hicks-Little CA, Koceja DM, et al. Modulation of soleus H-reflex by presynaptic spinal mechanisms during varying surface and ankle brace conditions. Neurophysiol Clin. 2007;37(1):15–21. doi: 10.1016/j.neucli.2007.01.007.
    1. Palmieri R, Ingersoll CD, Hoffman MA. The Hoffmann reflex: methodologic considerations and applications for use in sports medicine and athletic training research. J Athl Train. 2004;39(3):268–277.
    1. Sefton JM, Hicks-Little CA, Hubbard TJ, et al. Segmental spinal reflex adaptations associated with chronic ankle instability. Arch Phys Med Rehabil. 2008;89(10):1991–1995. doi: 10.1016/j.apmr.2008.03.014.
    1. Kaye AD, Kaye AJ, Swinford J, et al. The effect of deep-tissue massage therapy on blood pressure and heart rate. J Altern Complement Med. 2008;14(2):125–128. doi: 10.1089/acm.2007.0665.
    1. Weerapong P, Hume PA, Kolt GS. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med. 2005;35(3):235–256. doi: 10.2165/00007256-200535030-00004.
    1. WebMD Hypertension/High Blood Pressure Health Center. 2012. Available from: .
    1. Perlman AI, Ali A, Njike VY, et al. Massage therapy for osteoarthritis of the knee: a randomized dose-finding trial. PLoS One. 2012;7(2):e30248. doi: 10.1371/journal.pone.0030248.
    1. Bronfort G, Nilsson N, Haas M, et al. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev. 2004;(3) doi: 10.1002/14651858.CD001878.pub2. Art.Nb. CD001878.
    1. Kalichman L. Massage therapy for fibromyalgia symptoms. Rheumatology International. 2010;30(9):1151–1157. doi: 10.1007/s00296-010-1409-2.

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