Effects of a single-session massage for sedentary older women with prehypertension : a pilot study

Conclusion: A single session of Swedish massage was effective in reducing blood pressure and heart rate. Such intervention can be useful to provide safer levels of arterial blood pressure in sedentary older women with prehypertension. Effects of a single-session massage for sedentary older women with prehypertension: a pilot study ORIGINAL Fátima Aparecida Caromano1, Felipe Monte1, Maria Helena Morgani de Almeida1, Jéssica Cândido Jerônimo da Costa1, Priscila Santos Albuquerque1, Luiz Francisco Cachoni1, Jecilene Rosana CostaFrutuoso2, Leonardo Penteado Nascimento1, Francis Meire Favero2,3, Luiz Carlos de Abreu3, Mariana Callil Voos1,2

Effects of a single-session massage for sedentary older women with prehypertension: a pilot study

INTERNATIONAL ARCHIVES OF MEDICINE
Section: PhySical Medicine and Rehabilitation ISSN: 1755-7682

Introduction
Population aging is a global phenomenon.It is estimated that in 2050 there will be approximately two billion people aged 60 or more, and 80% of this population will be in developing countries.By 2025, Brazil will have the sixth higher number of older adults in the world. 1 Population aging may be associated with low quality of life and a higher prevalence of chronic diseases. 1,2n order to achieve better health and higher functional independence, it is necessary to minimize the number of environmental and behavioral risk factors for chronic diseases and to increase the frequency of protective factors.Physical activity, healthy diet, abstinence from smoking and alcohol, proximity to family and ergonomic environment are considered protective factors and promote healthy and functional aging. 1,2he National Health Policy for the Elderly (BRA-ZIL, 1999) aims to promote healthy aging, associated with the prevention of chronic diseases, such as hypertension. 2,3Hypertension is defined as a syndrome characterized by elevated blood pressure levels, associated with metabolic and hormonal changes and trophic modifications (cardiac and vascular hypertrophy).The prevalence is high and it is estimated that it is present in 15-20% of the Brazilian population, with a higher incidence among blacks and women. 3,4ver the years, there has been a slight elevation of blood pressure in young and older adults.A study with 6.525 people aged 18-74 years found mean values of 121 x 78 mmHg in people aged 18-44 years, 135 x 87 mm Hg in people aged 45-59 years and 148 x 86 mmHg in people aged 60-74 years. 5Determining the normal range for older adults is important to detect the onset of the disease.The World Health Organization considers the systolic measure 140-160 mmHg and the diastolic measure 90-95 mmHg as prehypertension in adults and older adults. 1,5 recent meta-analysis showed that the cardiovascular risk starts from measures 115 x 75 mmHg of arterial blood pressure, with a direct relationship between blood pressure levels, aging and death from vascular diseases. 6Prevention has great importance for the control of the disease. 6Among non-pharmacological measures, relaxations techniques, such as massage, have been described. 7he Swedish massage stimulates muscle metabolism and circulation.Kaye et al. (2008) demonstrated a that a single massage session decreased arterial blood pressure and heart rate. 12However, massage techniques habe been poorly explored as a complementary therapy for people with hypertension and prehypertension.The aim of this study was to identify the effects of a 60-minute single session of Swedish massage on blood pressure (BP) and heart rate (HR) in sedentary older women with prehypertension.

Methods
This study was conducted at Laboratory of Physiotherapy and Behavior of Physiotherapy Course of the Faculty of Medicine of University of São Paulo (Brazil).The study was approved by the Ethics Committee of the Institution, process 253/13.

Subjects
This pilot study included sedentary older women with arterial blood pressure (measured after 5 minutes at rest) higher than 130 x 80 mmHg and lower than 160 x 95 mmHg.Of the first 71 women sample, 13 were excluded, according to the exclu-sion criteria: having acute or chronic neurological, pulmonary or cardiac disease; having diabetes, cancer, dermatitis, edema or hematomas; using antihypertensive or diuretic drugs.Study participants were 58 women with mean age 64.5±1.4 years, mean height 1.59±0.19m, mean weight 72.6±6.8 kg (mean BMI 28.7±3.9kg/m 2 ).Thirteen participants were classified (according to BMI) as obese, 28 as being overweight and 18 within the normal weight range.
In order to adapt to the procedures, the participants were submitted to a Swedish massage session, a week before the intervention.They were also trained to collect BP and HR using OHROM® automatic device.In the following week, for five days mornings (at the same hour that the massage would be held), BP and HR were measured and recorded by the participants to establish a baseline.
The intervention consisted of the application of a 60-minute single session of Swedish massage performed in all parts of the body, except the genitals.The Swedish massage was performed by a physiotherapist with 30 years experience with massage techniques.BP and HR were collected immediately before and after the intervention.Pre and post intervention data were compared by Student's t tests.

Results
The mean baseline systolic blood pressure (SBP), considering the 5 days preceding the intervention was 131.0±3.0 mmHg.The mean systolic blood pressure (SBP) measured before the intervention was 139.1±3.5 mmHg.After the intervention, a 13.1% reduction occurred (p=0.022) and the mean SBP was 124.0±4.6 mmHg.
All participants showed a reduction in systolic and diastolic blood pressure and 32 of them had normal blood pressure levels after the massage.Also, mean BP and HR obtained on the 5-day baseline were compared with BP and HR measured before the massage session and no significant differences were found.

Discussion
In the present study, there was a decrease in systolic and diastolic BP in a group of sedentary older women with prehypertension, who underwent a single session of Swedish massage.Pre-intervention blood pressure level was compared to post intervention.
Prehypertension is a predictor of cardiovascular diseases and its treatment is primarily not pharmacological.Primary hypertension shows no clear cause, but the theory that it may be a response to chronic stress is accepted.Massage promotes relaxation [8][9][10][11][12] and our findings show that Swedish massage can be a therapeutic option for people with prehypertension.Cambron et al. (2006) studied different types of massage and its effects on blood pressure.They concluded that the Swedish massage has a positive effect in reducing blood pressure, while the trigger point therapy was associated with blood pressure increase. 13The Swedish massage acts on the muscle, soft tissues, tendons, fascia and connective tis-sues.The repeated sensory stimulation produced by this massage induces changes in the autonomic nervous system.Thus, the blood pressure is reduced due to sympathetic activity decrease. 13 study with 50 women with prehypertension, divided into experimental and control group, showed a significant decrease in systolic and diastolic blood pressure with ten 15-minutes Swedish massage sessions applied to the face, neck, shoulders and chest. 14Another study also observed arterial blood pressure reduction after a ten session program with 10-minute sessions of Swedish massage performed in the dorsal region of individuals with hypertension. 15onversely, Aourell et al. (2005) found evidence that contradicts theses studies.They compared the effects of Swedish massage on blood pressure, according to the massaged body surface.They found that massage applied to the back, neck and chest reduced systolic and diastolic blood pressure, whereas the massage on upper and lower limbs and face increased pressure levels. 16Although the Swedish massage is the most common type of massage technique, no previous studies had investigated the effects of this intervention when it was applied to all body surface in older women with prehypertension.
Although there are few studies about the massage intensity and its interference with arterial blood pressure, a recent study suggests that massage performed with moderate pressure (versus soft pressure) is effective mediating the benefits observed with massage therapy, modulating vagal activity. 17or massage treatment, many variables must be investigated in future studies, such as technique, duration, number of sessions, intensity, frequency, effects on body parts and populations.
This was a pilot study, restricted to sedentary older women with prehypertension, who underwent one 60-minute session of Swedish massage.It aimed to answer a specific question, however, this very specific population can also be considered a limitation of the study, which restricts generalization.

Conclusion
Our results showed that a single session of Swedish massage induced the reduction of arterial blood pressure and heart rate on sedentary older women with prehypertension.This indicates that massage may be a complementary therapy in the treatment of hypertension.
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