The Effect of Light Massage on Hemodynamic in Patients with
Heart Failure
A Systematic Review
Galih Noor Alivian
1
, Nursalam
1
and M. Hasinuddin
2
Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia
2
STIKES Ngudia Husada Madura, Bangkalan, Indonesia
Keywords: Massage, Light Massage, Heart Failure.
Abstract: Massage is a general body skin stimulation, centered on the back and shoulders, or can be done on one or
several parts of the body and performed about 10 minutes of each part of the body to achieve maximum
relaxation results. Light Massage (soft touch) is the basis of massage therapy and also combines science and
art. Determining the exact amount of pressure for each person and finding the area of tension and other soft
tissue problems can use a sense of touch. Touch also conveys caring, an important component in relation to
healing. The purpose of this systematic review is to determine the effect of light massage on hemodynamic
changes in heart failure pati ents. The article search was done on 7 data base to answer the purpose of this
review. From some articles that have been reviewed can be said that massage massage massage therapy is
one good alternative choice in stabilizing hemodynamic patients with heart failure. While to conclude
massage therapy massage light is one of the best alternatives requires a lot of random clinical studies that
compare light massage with various other therapies.
1 BACKGROUND
Heart disease is the number one cause of death in the
world. This disease is not only a problem in
developed countries, but also developing countries
including Indonesia. Based on research conducted
by a health agency in Indonesia, it turns out heart
disease is also the number one killer in Indonesia
today.
World Health Organization (WHO) in 2012
showed 17 million people die every year due to heart
disease and blood vessels around the world. A total
of 83.6 million people in the United States have
heart attacks and 478,000 people die from coronary
heart disease, even in 2030 by 40.8% of Americans
suffering from heart disease (AHA, 2013).
One of the most common heart disorders is heart
failure. Heart failure is a major health problem,
where the prevalence of heart failure in developing
countries is high and increasing. Half of patients
diagnosed with heart failure still have a life
expectancy of 5 years but about 250,000 patients die
by heart failure either directly or indirectly each
year, the rate has increased 6 times in the last 40
years. The risk of death each year is 5 - 10%,
patients with mild symptoms will increase to 30-
40% until the onset of disease (Joesoef, 2007).
Heart failure consists of six clinical
classifications according to the 2008 European
Society of Cardiology (ESC) guidelines, which
include decompensated heart failure, acute
pulmonary edema, hypertensive heart failure,
cardiogenic shock, isolated right heart failure, and
heart failure with acute coronary syndromes (SKA ).
Diagnosis of heart failure is based on anamnesis,
clinical judgment, and investigation of
electrocardiogram (ECG), chest X-ray, laboratory
examination, and Doppler echocardiography
(Manurung, 2009). The electrocardiogram is a
graphic representation of the electrical potential
variations generated by cardiac muscle excitation
and is detected on the surface of the body (Dorland,
2012).
Early detection and recognizing features quickly
can help prevent deterioration and maximize the
healing process. One of the measures to recognize
such traits is regular and rigorous hemodynamic
monitoring (Gwinmut, 2006 in Jevons and Ewens,
2009).
446
Alivian, G., Nursalam, . and Hasinuddin, M.
The Effect of Light Massage on Hemodynamic in Patients with Heart Failure.
DOI: 10.5220/0008326604460451
In Proceedings of the 9th International Nursing Conference (INC 2018), pages 446-451
ISBN: 978-989-758-336-0
Copyright
c
2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
One of the therapies to help to stabilize
hemodynamics is by relaxing muscles, one with
massage. Massage is a general body skin
stimulation, centered on the back and shoulders, or
can be done on one or several parts of the body and
performed about 10 minutes of each body part to
achieve maximum relaxation results (Tamsuri 2006).
Massage can also correct problems in the muscle
joints, flexing the body, restoring tension and easing
pain. In addition massage can improve blood
circulation, and reduce anxiety and depression
(Handoyo, 2000).
Light Massage is the basis of massage therapy
and also combines science and art. Determining the
exact amount of pressure for each person and
finding the area of tension and other soft tissue
problems can use a sense of touch. Touch also
conveys caring, an important component in relation
to healing (Situmorang, 2009).
2 METHODS
2.1 Article Search
In search of this first scientific article by formulating
a PICOT framework. The population is a patient
suffering from heart failure. The intervention is
massage therapy (massage massage) to stabilize
hemodynamics in patients with heart failure,
outcomenya is the effectiveness of massage therapy
(light massage) to stabilize hemodynamics in
patients with heart failure. So the research question
questionnaire is obtained, how the effectiveness of
massage therapy (light massage) to stabilize
hemodynamics in patients with heart failure?
The next stage is to search the scientific articles
conducted by using electronic databases namely
Sage journal, google scholar, proquest, Ebsco and
science direct. In the search of this scientific article
carried out restrictions only on articles that speak
English only and published between 2000 to 2016.
Search articles using keywords that is massage, light
massage, hemodynamics, and heart failure. Before
starting the literature search first determine the
inclusion and exclusion criteria. The inclusion
criteria are (a) abstract and full text articles (b) the
main research articles dealing with heart failure with
massage therapy. The exclusion criterion is (a) not
English (b) contains no abstract (c) discusses heart
failure with other therapies.
In determining an article selected by the
researcher the main thing to do is to look at the
search-related keyword in electronic data-based,
then by determining whether the inclusion and
exclusion criteria are achieved, followed by a review
of the full-text version. Articles found as many as
1667, and 489 articles discussing therapeutic
massage therapy/ light massage and heart failure.
Articles that enter inclusion criteria and reviewed as
many as 11 articles. Schematically can be seen in the
following PRISMA diagram (Preferred Reporting
Items for Systematic Meta-Analyzes):
2.1.1 Quality and Level Assessment of
Articles
In this case to determine the quality and level of
articles of all articles that have been selected
dilakuan assessment in accordance with the tools of
each research design and carried out critical
appraisal using tools from The Joanna Briggs
Institute Critical Appraisal tools for use in JBI
Systematic Reviews. The next step is to assess the
quality of existing articles that depend on the design
used and the methods in the article. In this
assessment, the criteria of articles with high quality
are 80% -100%, the articles with the middle quality
is 70% -79%, and the low quality articles are <69%.
The next step was an assessment of the quality of the
eviden and strength of the recommendation using
GRADE, a system used by BMJ (Atkins et al.,
2004).
Articles based on
keywords :
massage, light
massage,
hemodinamik, and
heart failure, (n
=1158)
Articles from the
database:
CINAHAL Ebsco,
SAGE Journal, Google
Scholar, Science Direct,
and ProQuest 2006-
2017 (n = 1667)
Articles that has been
screened:
(n = 489)
Article based on
exclusion criteria:
(n=400)
Article based on
inclusion criteria:
n = (11)
11 articles selected
The Effect of Light Massage on Hemodynamic in Patients with Heart Failure
447
3 RESULTS
From the literature study conducted, found 10
articles that discuss about massage and gentle
massage to hemodynamic changes of patients with
heart failure. The following will be described the
results of the article review.
Yang Xiaochen et al (2014) investigated about
chinese massage (tuina) for the treatment of essential
hypertension, Seven randomized trials involving 479
patients were included. The results of Meta-analysis
showed superior effects of Tuina plus
antihypertensive drugs compared to antihypertensive
drugs alone, however, Tuina alone was not superior
to antihypertensive drugs. The safety of Tuina for
EH was still unclear because adverse effects were
not assessed in most of the original trials.
Bennett, Surussawadi et al, (2015) investigated
about Acute effects of traditional Thai massage on
cortisol levels, arterial blood pressure and stress
perception in academic stress condition. There were
no significant differences in cortisol level between
the two groups. The results suggest the need for
further study into other possible physiological
effects on stress of TTM.
Muller, Jasmin et al (2016) ) investigated the
Mechanical massage and mental training programs
effect employees’ heart rate, blood pressure and
fingertip temperature. Within-group analysis showed
that mechanical massage decreased heart rate (p =
0.038) and blood pressure (systolic p = 0.019,
diastolic p = 0.026) and increased fingertip
temperature (p = 0.035). Mental training programs
reduced heart rate (p = 0.036). Combining the two
methods increased diastolic blood pressure (p =
0.028) and decreased fingertip temperature (p =
0.031). The control group had a significant decrease
in systolic blood pressure during the first four weeks
of the study (p = 0.038).
Nelson, Nicole L, et al (2015) investigated about
massage therapy: understanding the mechanisms of
action on blood pressure. Based on this analysis, six
potential blood pressure mediating pathways were
identified. Current theories suggest that massage
therapy exerts sympatholytic effects through
physiologic and psychological mechanisms,
improves hypothalamus-pituitaryadrenocortical
(HPA) axis function, and increases in blood flow,
which, in turn, may improve endothelial function.
Supa’at, Izreen et al (2013), investigated about
effects of swedish massage therapy on blood
pressure, heart rate, and inflammatory markers in
hypertensive women. Massage group (𝑛 = 8) showed
significant systolic BP (SBP) reduction of 12mmHg
(𝑃 = 0.01) and diastolic BP (DBP) reduction of
5mmHg (𝑃 = 0.01) after four sessions with no
significant difference between groups. Reductions in
HR were also seen in massage group after sessions
1, 3, and 4 with significant difference between
groups. Therewere no changes in ICAM-1. In
conclusion, SMTor resting an hourweekly has
effects on reducing BP, HR, and VCAM-1 in
hypertensive women.
Eguchi, Eri et al, (2016) investigated about the
effects of aroma foot massage on blood pressure and
anxiety in japanese community-dwelling men and
women. Aroma foot massage significantly decreased
the mean SBP (p = 0.02), DBP (p = 0.006), and state
Table 1: Quality and level assessment of articles.
Author/Country
Research
Design
(Yang, Xiaochen
et al, 2014)
China
A Systematic
Review and
Meta-
Analysis
(Bennett,
Surussawadi et
al, 2015),
Thailand
RCT
(Muller, Jasmin
et al, 2016),
Sweden
An
exploratory
pilot study
(Nelson, Nicole
L, et al 2015),
Florida
A Scoping
Review
(Supa’at, Izreen
et al, 2013),
Malaysia
RCT
(Eguchi, Eri et
al, 2016) Japan
RCT
(Cambron,
Jerrilyn A. Et al,
2006) Lombard
A Preliminary
Study
(Ejindu, Anna,
2007) UK
Crossover
pilot study
(Heeyoung oh,
Myung-haeng
hur, et al, 2007)
Korea
Observasional
study
(Cutshall,
Susanne M. Et
al, 2010) United
States
A pilot study
(Trihartini Mira,
et al, 2010)
Indonesia
Pre
experimental
design
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
448
anxiety (p = 0.003) as well as the proportion of
participants with anxiety (p = 0.003).
Research by Cambron, Jerrilyn A. Et al (2006) about
changes in blood pressure after various forms of
therapeutic massage. Swedish massage had the
greatest effect at blood pressure reduction. Trigger
point therapy and sports massage both increased the
systolic blood pressure, and if both forms of
massage were included in a session, both the systolic
and diastolic blood pressure readings significantly
increased.
Ejindu, Anna (2007) investigated about the effects
of foot and facial massage on sleep induction, blood
pressure, pulse and respiratory rate. A drop in
systolic blood pressure of 8.5mmHg was recorded
immediately after facial massage compared to that of
1mmHg recorded after foot massage. Both
treatments were equally effective in reducing
subjective levels of alertness during the
interventions, with face massage marginally better at
producing subjective sleepiness.
Research by Heeyoung oh, Myung-haeng hur, et al
(2007) about effects of aromatherapy massage on
blood pressure and lipid profile in korean climacteric
women. The subjects comprised 58 climacteric
women: 30 in the experimental group and 28 in the
control group. The intervention produced significant
differences in the systolic blood pressure compare to
pretreatment and significant differences in systolic
and diastolic blood pressures at posttreatment
between the two groups.
Cutshall, Susanne M. Et al (2010) investigated about
effect of massage therapy on pain, anxiety, and
tension in cardiac surgical patients. Statistically and
clinically significant decreases in pain, anxiety, and
tension scores were observed for patients who
received a 20-minute massage compared with those
who received standard care. Patient feedback was
markedly positive.
Trihartini Mira, et al (2010), about cutaneus
stimulation: slow-stroke back massage reduces the
intensity of osteoartritis pain of elderly. The Resul
showed that the message intervention was signifi
cantly affect the elder’s level of osteoarthritis pain in
Panti Werdha Hargo Dedali Surabaya (p = 0.003).
4 DISCUSSION
Massage is a general body skin stimulation, centered
on the back and shoulders, or can be done on one or
several parts of the body and performed about 10
minutes of each body part to achieve maximum
relaxation results (Tamsuri 2006). Massage can also
correct problems in the muscle joints, flexing the
body, restoring tension and easing pain. In addition
massage can improve blood circulation, and reduce
anxiety and depression (Handoyo, 2000). Massage
also affects the flow of lymph, muscle, nerves, and
the digestive tract and stress (B. Mahendra, Yoan
Destarina, 2009). Massage is a touch of the soft
tissues of the body by the use of the hands as a
means to positively affect the blood vessels,
muscles, and nervous system of the body (Clay &
Pounds, 2008).
Light massage can provide a greater sense of
pleasure and relaxation. Speed and pressure during
massage is done in a subtle way, much like a mother
calms her baby. The nerve sends a pleasure signal to
the brain when massaged at 1-10 cm. The benefit of
a light massage is to stimulate the afferent nerve that
leads to the brain. It mainly works on the peripheral
nervous system, the nerve C-tactile nerve fibers.
This nerve sends signals related to emotions and
positive feelings (Situmorang, 2009). Light massage
for 15 minutes can increase delta waves and
decrease alpha and beta waves. The delta waves
indicate very relaxed conditions (Field, et al., 1996).
Light massage for 15 minutes also decreases the
right frontal asymmetry EEG associated with
affective and negative mood (Davidson, 2006).
Furthermore, from 10 articles reviewed revealed the
effect of massage on hemodynamic changes (blood
pressure, breathing, and heart rate). According to
(Yang Xiaochen et al, 2014) the effects of chinese
massage (tuina) for the essential treatment of
hypertension show significant results on the
decrease in blood pressure in the treatment group. It
is also suggested by (Cutshall, Susanne M. Et al,
2010), who examined the effects of massage therapy
on pain, anxiety, and blood pressure on patients'
heart surgery, statistically and clinically significant
decreases in pain scores, anxiety, and blood
pressure. Ejindu, Anna (2007) significantly the
massage affects against blood pressure, pulse and
respiration. (Cambron, Jerrilyn A. Et al, 2006) said
that overall, systolic blood pressure decreased 1.8
mmHg and diastolic blood pressure increased 0.1
mmHg, massage therapy associated with changes in
blood pressure had the greatest effect on reducing
blood pressure. From some articles that have been
reviewed on average show a positive effect of
massage therapy on blood pressure, breathing, and
heart rate. Research using massage therapy has been
widely performed which proves to be safe and has a
positive effect in lowering blood pressure, breathing,
and heart rate.
The Effect of Light Massage on Hemodynamic in Patients with Heart Failure
449
This is consistent with the results of this review
integrative of 10 articles all of which concluded that
massage therapy is effective against hemodynamic
changes although there are articles that do not show
any significant influence. However, massage therapy
shows a positive effect and can accelerate in
lowering blood pressure, breathing and heart rate.
5 CONCLUSIONS
Massage therapy is one of the alternative therapies
that have good results in stabilizing hemodynamics
(blood pressure, breathing, and heart rate) according
to some articles that have been reviewed. However,
to be regarded as one of the best alternatives
compared to other alternatives requires other
randomized clinical studies, which compare
alternative therapy with massage therapy.
REFERENCES
American Heart Association (AHA). 2013. 2013
ACCF/AHA guideline for the management of heart
failure: A report of the American College of
Cardiology Foundation/American Heart Association
task force on practice guidelines. J Am Coll Cardio,
62(16), e240-e327.
Atkins, D., Best, D., Briss, P. A., Eccles, M., Falck-Ytter,
Y., Flottorp, S., GRADE Working Group. (2004).
Grading quality of evidence and strength of
recommendations. BMJ (Clinical Research Ed.),
328(7454), 1490.
https://doi.org/10.1136/bmj.328.7454.1490
Bennett, S., Bennett, M.J., Chatchawan, U., Jenjaiwit, P.,
Pantumethakul, R., Kunhasura, S., Eungpinichpong,
W., 2015, Acute effects of traditional Thai massage on
cortisol levels, arterial blood pressure and stress
perception in academic stress condition: a single blind
randomised controlled trial, Journal of Bodywork &
Movement Therapies, doi:
10.1016/j.jbmt.2015.10.005.
Cambron Jerrilyn a., d.c., m.p.h., ph.d., jennifer
dexheimer, .m.t., patricia coe, d.c., c.m.t, 2006,
Changes in Blood Pressure After Various Forms of
Therapeutic Massage: A Preliminary Study, The
Journal Of Alternative And Complementary Medicine,
vol 12, , number 1, 2006, pp. 65–70
Cutshall Susanne M, Laura J. Wentworth, Deborah Engen,
Thoralf M. Sundt, Ryan F. Kelly, Brent A. Bauer,
2010, Effect of massage therapy on pain, anxiety, and
tension in cardiac surgical patients: A pilot study,
Complementary Therapies in Clinical Practice, Vol.
16 (2010) 92–95, doi:10.1016/j.ctcp.2009.10.006.
Clay. J. H., Pounds. D. M., 2008. Basic Clinical Massage
Therapy: Integrating Anatomy and Treatment. Second
Edition. Lippincott William and wiskins: walnut
street, Philadelphia.
Davidson, G.C. Neale, J.M. dan Kring, A.M. 2006.
Psikologi Abnormal. Edisi ke -9. Jakarta: PT Raja
Grafindo Persada.
Dorland WAN, 2012. Kamus kedokteran Dorland. 31th
ed. Jakarta: EGC.
Eguchi E, Funakubo N, Tomooka K, Ohira T, Ogino K,
Tanigawa T (2016) The Effects of Aroma Foot
Massage on Blood Pressure and Anxiety in Japanese
Community-Dwelling Men and Women: A Crossover
Randomized Controlled Trial. PLoS ONE 11(3):
e0151712. doi:10.1371/journal.pone.0151712
Ejindu, Anna, 2007, The effects of foot and facial massage
on sleep induction, blood pressure, pulse and
respiratory rate: Crossover pilot study,
Complementary Therapies in Clinical Practice, Vol
13, 266–275, doi:10.1016/j.ctcp.2007.03.008.
Handoyo, 2000. Manfaat Massase Relaksasi, diakses
tanggal 27 Agustus 2017
<http://massage.about.com/od/tensiontamers/a/relaxati
on_therapy.htm>
Heeyoung oh Myung-haeng hur, Lee Myeong Soo, Kim
Chan, Choi Ae-na, 2007, effects of aromatherapy
massage On blood pressure and lipid profile In korean
climacteric women, Intern. J. Neuroscience, Vol
117:1281–1287, doi: 10.1080/00207450600936650
Jevons, P & Ewens, B. 2009. Monitoring the critical ill
essensial skills for nurses (d. Vidhia Umami, Trans):
Blackwell Publishing Ltd
Joesoef, A.A., 2007. Parkinson’s Disease : Basic Science
dalam Parkinson’s Disease & Other Movement
Dissorder, Pustaka Cendikia Press.
Manurung D, 2009. Gagal jantung akut. Dalam (Sudoyo
AW, Setiyohadi B, Alwi I, Simadibrata M, Setiati S,
eds). Buku ajar ilmu penyakit dalam, 5th ed. Jakarta:
Pusat Penerbitan Departemen Ilmu Penyakit Dalam
Fakultas Kedokteran Universitas Indonesia, p. 1586-
95.
Mullera Jasmin, Ekströma Anette, Harléna Mikael,
Lindmarkb Ulrika, Handlin Linda, 2016, Mechanical
massage and mental training programs effect
employees’ heart rate, blood pressure and fingertip
temperature-An exploratory pilot study, European
Journal of Integrative Medicine, Vol 8. (2016) 762–
768 http://dx.doi.org/10.1016/j.eujim.2016.06.002
Nelson NL, 2015, Massage Therapy: Understanding the
Mechanisms of Action on Blood Pressure. A Scoping
Review, Journal of the American Society of
Hypertension, doi:10.1016/j.jash.2015.07.009.
Situmorang, 2009. Teknik relaksasi massage. USU Press.
Medan
Supa’at Izreen, Zakaria Zaiton, Maskon Oteh, Aminuddin
Amilia, Nordin Nor AnitaMegat Mohd, 2013, Effects
of Swedish Massage Therapy on Blood Pressure,
Heart Rate, and Inflammatory Markers in
Hypertensive Women, Evidence-Based
Complementary and Alternative Medicine, Vol 2013,
Article ID 171852, 8 pages.
http://dx.doi.org/10.1155/2013/171852
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
450
Tamsuri, A., 2007, Konsep dan penatalaksanaan nyeri.
Jakarta: EGC
Triharini Mira, Mardliyah, Hadisuyatmana Setho 2010,
Cutaneus Stimulation: Slow-Stroke Back Massage
Reduces The Intensity Of Osteoartritis Pain Of
Elderly, Jurnal Ners, Vol 5, No 1 (2010),
http://dx.doi.org/10.20473/jn.v5i1.3928
Yang X, Zhao H, Wang J, 2014, Chinese Massage (Tuina)
for the Treatment of Essential Hypertension: A
Systematic Review and Meta-Analysis,
Complementary Therapies in Medicine ,
http://dx.doi.org/10.1016/j.ctim.2014.03.008
The Effect of Light Massage on Hemodynamic in Patients with Heart Failure
451