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Corresponding author:
Zinat Mohebbi, MSC; Department of Nursing, School of Nursing, Student Research Committee, Shiraz
University of Medical Sciences, Postal Code: 1311971936, Shiraz, Iran
Tel: +98 71 36474254; Fax: +98 71 36474252; Email: mohebbi04@yahoo.com
Abstract
Background: Tension and stress are among the factors that lead to hypertension. In most individuals,
behavioral strategies, such as relaxation and massage, are effective in controlling the individuals
response to stress, thus reducing hypertension.
Methods: This non-blind clinical trial was conducted on 90 patients with primary hypertension. The
patients were randomly divided into a control and an intervention group. In both groups, blood pressure
was measured and recorded twice a week before and after a 10-min Swedish back massage and rest
for 6 weeks. The study data were collected using a questionnaire including demographic information,
a check list of blood pressure record, and a fixed manometer.
Results: In the intervention group, systolic and diastolic blood pressure decreased to 6.44 and 4.77
mmHg, respectively after back massage (P<0.001).
Conclusion: The obtained results were indicative of the effectiveness of back massage in reducing
blood pressure in the study participants. Using stress control methods, such as massage, is a simple,
acceptable, and teachable method for families to control blood pressure. After conducting more studies
on this issue, back massage can be recommended as a non-pharmacological method to control blood
pressure.
Trial Registration Number: IRCT2013112615552N1.
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The effect of back massage on blood pressure
Enrollment
Excluded (n=0)
Not meeting inclusion criteria (n=0)
Declined to participate (n=0)
Other reasons (n= 0)
Randomized (n=90)
Analyzed (n=45)
Analysis Analyzed (n=41)
Excluded from analysis (n=0) Excluded from analysis (n=0)
Figure 1: Flow diagram of the patients progress through the stages of the randomized clinical trial
Swedish massage from the neck to the back into the SPSS statistical software (v. 15).The
(from shoulders to waist) with compression demographic data were analyzed using t-test
(including a muscular pressure, one muscle or and chi-square test. After calculating the
part of it, applying and then releasing pressure, means and standard deviations at different
proceeding to adjacent areas and repeating), times, repeated measures ANOVA was used
continued with pushing, tapotement (tapping for analyzing the variables. P<0.05 was
muscles with the side of the hand and fingers considered as statistically significant.
and side closed fist including more provocative
movements), and then with wringing (two Results
hands move against each other and the
muscles are compressed between them). The The intervention group included 25 females and
intervention group referred on Saturdays and 20 males, while the control group included 27
Sundays and the control group referred on females and 18 males. However, four female
Mondays and Tuesdays from 8 A.M. to 1 P.M. participants in the control group were excluded
In both control and intervention groups, the from the study because they did not refer to
patients rested for 5 min and then, their BPs the clinic; thus, the control group consisted
were recorded. BP was recorded twice a week of 41 patients. Comparison of demographic
before every intervention for 6 weeks. In the characteristics in the two groups has been
intervention group, an oil (sesame oil) was presented in table 1. Accordingly, no significant
rubbed with soft movements on the back of difference was observed between the two
the patient and back massage was performed groups regarding sex, education level, marital
from the neck to the entire back area (from status, occupation, and age.
shoulders to waist) for 10 min. Immediately The means and standard deviations of
after the 10-min massage, BP was recorded changes in systolic BP were compared in the
again. In the control group, the patients two groups before and after the intervention,
rested for 10 min and BP was recorded and the results have been shown in table 2.
afterwards. The study data were collected As the table depicts, the mean of systolic BP
using a questionnaire including demographic decreased to 6.44 mmHg in the intervention
information and a checklist of BP records. group and the difference was statistically
After data collection, they were entered significant. In the control group also, the mean
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The effect of back massage on blood pressure
Table 2: Comparison of changes in systolic blood pressure in the intervention and control groups before and after
the intervention
Mean systolic blood pressure in the Mean systolic blood pressure in the
intervention group control group
Sessions SD SD
Before the After the Before the After the
intervention intervention intervention intervention
1th session 141.2814.18 133.5513.88 140.9714.44 138.2112.47
2nd session 135.5310.95 128.579.97 142.6011.85 140.2611.08
3rd session 137.7311.77 130.3310.70 139.5811.41 137.349.88
4th session 139.8210.64 133.4410.77 140.3410.74 137.659.54
5th session 139.429.07 133.428.22 141.269.79 138.468.58
6th session 137.939.67 131.119.14 140.739.63 138.688.43
7th session 135.809.19 129.669.02 139.689 138.567.42
8th session 137.487.54 131.118.14 141.467.89 139.706.75
9th session 139.488.74 133.048.20 139.858.59 138.437.85
10th session 140.488.01 135.047.95 141.788.55 140.177.56
11th session 139.557.48 133.467.86 139.787.84 133.688.14
12th session 139.227.22 133.668.24 140.147.49 139.297.08
Used test Repeated measures ANOVA Repeated measures ANOVA
F 11.39 2.29
P value P<0.001 P=0.052
Figure 2: Trend of changes in the mean of systolic blood pressure in the intervention and control groups based
on time
Table 3: Comparison of the mean changes in diastolic blood pressure in the intervention and control groups
before and after the intervention
Mean diastolic blood pressure in the Mean diastolic blood pressure in the
intervention group control group
Sessions SD SD
Before the After the Before the After the
intervention intervention intervention intervention
1th session 93.8614.43 88.7312.64 90.9016.19 88.7514.68
2nd session 87.0810.33 81.668.91 93.2615.40 91.2614.13
3rd session 90.6011.86 84.2211.13 91.9510.57 90.219.26
4th session 91.2611.01 86.3510.12 92.3611.66 90.0910.38
5th session 90.7711.67 86.2010.33 93.2411.33 90.9710.85
6th session 90.0210.53 84.288.03 90.639.35 89.218.07
7th session 88.4411.54 83.359.76 90.538.45 89.197.77
8th session 88.689.46 83.808.99 92.5310.78 91.099.39
9th session 91.6211.04 88.539.90 91.1210.46 89.978.85
10th session 92.869.35 89.178.75 94.5110.15 93.299.31
11th session 92.268.49 87.887.69 90.587.36 89.897.02
12th session 90.447.97 86.426.89 91.909.64 91.368.75
Used test Repeated measures ANOVA Repeated measures ANOVA
F 7.36 1.2
P value P<0.001 P=0.23
Figure 3: Trend of changes in the mean of diastolic blood pressure in the intervention and control groups based
on time
the control group from sessions 112, and the and diastolic BP was clinically significant only
results of repeated measures ANOVA indicated in the intervention group.
that the differences were statistically significant
(P<0.001). Furthermore, the effect of time, Discussion
group, and time*group on systolic and diastolic
BP in the two groups was assessed using The results of the present research showed that
repeated measures ANOVA, and the results after the intervention, the patients means of
have been depicted in table 4. According to the diastolic and systolic BP respectively decreased
heart specialist comments, decrease in systolic to 6.44 and 4.77 mmHg in the intervention
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Table 4: The effect of time, group, and time*group on systolic and diastolic blood pressure
Effect Blood pressure df F P value
Systolic 24 8.9 P<0.001
Time
Diastolic 24 4.81 P<0.001
Systolic 1 10.77 P=0.002
Group
Diastolic 1 5.34 P=0.02
Systolic 24 3.96 P<0.001
Time*Group
Diastolic 24 2.77 P<0.001
group and to 2.31 and 1.51 mmHg in the further studies are recommended to apply
control group. Thus, the results indicated the massages on the whole body and for a longer
effectiveness of massage in controlling BP. In period of time. Yet, number of massage
the same line, a study in Hong Kong showed sessions and number of participants were the
that massage by superficial stroke method for strong points of this study.
10 min performed for 7 consecutive days was
effective in reducing hypertension in the elderly Conclusion
individuals with stroke.13 A similar study also
investigated the effects of Swedish massage on Based on the results of the present study, 12
BP, heart rate, and inflammatory markers in the sessions of back massage reduced systolic and
women with hypertension. In that study, the diastolic BP in the patients with hypertension.
participants were divided into an intervention Thus, after conducting more studies on this
and a control group each containing eight issue, back massage can be recommended as
patients. The results revealed a significant a non-pharmacological method for BP control.
reduction in systolic and diastolic BP after the
fourth session.14 Consistently, another study Acknowledgment
showed that systolic and diastolic BPs decreased
after 10 sessions of back massage. In that study, The present article was extracted from the
however, the study participants served both thesis written by Mr. Mehdi Moghadasi and
as the intervention and the control group.12 was financially supported by Shiraz University
One other study in Karolina also evaluated of Medical Sciences (Grant No: 92/71404).
the effect of massage by superficial stroke The authors would like to acknowledge all
method on mental and physical symptoms of the patients who accepted to participate in this
rehabilitation patients. The findings of that study research. They are also grateful for Ms. A.
demonstrated a significant reduction in BP after Keivanshekouh at the Research Improvement
the intervention.15 However, another study on Center of Shiraz University of Medical
massage showed no significant changes in Sciences for improving the use of English in
systolic and diastolic BP.16 Nonetheless, the the manuscript.
results of the studies by Christin M. Olney,
Mohammad Reza Yeganehkhah et al., Moeini Conflict of Interest: None declared.
et al., ebnem inar et al., and Mak Namara et
al. showed that massage therapy considerably References
decreased diastolic and systolic BP.4,17-20
This is indicative of the effect of this non- 1 Messerli FH. Definition of Hypertension.
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One of the limitations of the current study ed. New York: Springer; 2011. p. 1-2.
was that back massage was performed on the 2 Chobanian AV, Bakris GL, Black HR, et
aforementioned areas for 10 min. Therefore, al. Seventh Report of the Joint National
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