The effect of foot-bath with or without the essential oil of lavender on the autonomic nervous system: A randomized trial

t 0 -

THE EFFECT FOOT-BATH OR WITHOUT

OF YYITH THE

ESSENTIAL

OIL

LAVENDER AUTONOMIC

OF

ON

NERVOUS

THE

SYSTEM:

A RANDOMIZED TRIAL Y. SAEKI

S

ummary - Objectives: was designed effect

without

of

to investigate foot-bath

the essential

the autonomic

study.

Japan.

Intervention:

activity

foot-bath

appear

to be associated

significant

and

recorded.

Autonomic

evaluated

using

bath

caused

respiratory icant

spectral nerve during

in

analysis, activity

finger tip blood rate

blood

was

analysis

of

in heart

or

flow.

Using

were delayed changes

In

with the addi-

oil of lavender,

there

to the balance

of

This

article

Complementary

Therapies

Although

it

1995;

to a good

Hudson,

into the

Blamery,

1994),

general

physiological

effects

of foot-

trial was negative

bathing

on the human

body.

of nursing

care

settings,

by nurses as part of a holistic

approach

to patients

Carter,

1994;

(Sanderson

Stevensen,

Trevelyan and Booth, Spurling,

aromatherapy

1994; Lis-Balchin, 1998).

is

and 1994a;

generally

Although used

to

quality of life at both psycholevels, so far it

did produce ment (Buckle,

in

(Dale and Cornwell, investi-

and physiological oil in human

have

oil did not change

parameters

such as blood

or heart rate (HR), psychological

mood

and

1993; Stevensen,

et al., 1995).

and

a controlled

simultaneously

shown that essential

(BP)

(Burns

though

effects of essential

pressure

reports oils may

or pain and promote

gating psychological

physiological

sleep in Cannard,

Other

humans

Studies

may

night’s

that essential

alleviate anxiety

1994).

inhalation studies have

1994;

1995).

have suggested

research

has been used in a

after Some

(Hudson,

is little

1997;

in providing

humans

being,

wide variety

An

demon-

aromatherapy

in

Aromatherapy

1997).

in

levels

1994b; Dunn

tial oils seem likely to produce effect,

improve-

anxiety

Thus, although

cial psychological

but

the essena benefl-

no physiolog-

in

seems that very few reports have shown

in Medicine

evidence for the efficacy of essential oils

ical effects on the human body have yet

(Lis-Balchin,

been demonstrated.

appeared

2000; 8: 2-7.

doi:10.1054/ijar.2000.0039,

that

relaxation

logical and physiological originally

1991).

and sense of well-

there

al.,

animals

of lavender

role

improve Footnote:

oil

contribute

can

of the foot or

function.

oils

effect

strated the sedative effects of the essen-

performed

procedure

et

using

for patients’ comfort

especially

significantly

types of foot-bath.

(Lis-Balchin

experiment

antibacterial

plays an important

a signif-

the parasympathetic

the case of the foot-bath tion of essential

were

Results: The foot-

increased

the both

This

foot

rates, but produced

increase

practice.

skin integrity

function

vitro

suggested is a frequently

maintain

no changes

autonomic

Young

maintain

spectral

heart rate variability.

in

measures:

respiratory

with small but

a potent

tial

nursing

flow

oil of lavender

that many plant essential

have

(Buchbauer,

with and without

Outcome

reported

activity.

water for 10 minutes

An electrocardiogram,

and

direction

Conclusion:

college,

women sat with their feet soaked in hot

oil.

the

changes

Foot-bathing

the essential

in

with relaxation.

A hot

controlled

Nursing

associated

or

system. Design:

crossover

autonomic

on

with

Setting:

Nagano,

the

oil of lavender

nervous

Randomized

This study

available online

at http://www.idealibrary.com

1997).

on

It

IOE~L’

has

been

Recently,

analysis

of heart rate variability used

to evaluate

system function Pagani

(HRV) has been

autonomic

(Pomeranz

et al., 1986;

Saeki

et

al.,

nervous

et al., 1985;

Oka et al., 1995;

1997).

Power

spectral

obtained.

A sample

female subjects, chosen

as

of

the

of

this

study.

current

The

history

tion of alcohol or tobacco,

components: nent

major

a high-frequency

(HFC)

component

and

a

(LFC).

and is modulated

by

atropine LFC

to

and

systems.

This

an

and propranolol

been

The

proposed

sympatho-vagal

as

a useful parameter

main

basin,

giving a 0.05%

temperature

jointly

by the

autonomic

without the addition peutic essential

effect

(Stevensen, Booth,

no

func-

three condi-

sitting

lots for

10 minutes

spectral

nervous

was

system

with and

(Lavender oil that is

and calming side-effects

Trevelyan

from the Nagano Laboratory

nature,

purpose,

written

study College

Committee.

UK.),

on a microcomputer 7100/8OAV,

Apple,

Japan).

algorithm.

by a fast-peak

of

oil followed

by one with the

lasted

oil. The

other

five subjects

with the essential

10 minutes.

it. Each

After

soaking,

oil soak the

HRV.

The

used (Hyper

component

high-frequency

60

minutes

of data collection

first soak. Data were collected minutes

continuously

each

before

condition,

beginning

HRV

of

flow

the

21,

Advance

subjects

after

selected

Co.

breathed

for 20

minutes

recorded

minutes

- period

after

(BF)

the

the

soak;

of 2 minutes

5

before

after the start of

10 minutes immediately

-

period

before

of 2

the

feet

from the foot-bath;

and and

(ALF The

spontaneously

and

the

before

-

of the 3

of 2 minutes

Japan).

(NEC

baseline

of 2 minutes

after - period

flowmeter

LTD.,

were

were removed

Japan)

around

soak;

periods

recording

palmar

band

electrocardiogram

period

and after 5 minutes the

calculated or each soak

was measured

of the

respiratory wrapped

as follows:

middle

minutes

finger-tip

also

data for 2 minute

for the

the soak.

component

For control

out of each 20 minute

3 minutes

to 7 minutes

(LFC, 0.02-0.15

soak

for each subject from

low-

was

of

condition,

at least

area of of HRV

ratio

in a dry bath towel

completion

The

Hz). The LFC to HFC

and then wrapped

occurred

Wave, Kissei

(HFC, 0.15-0.40

(LFC-HFC).

second

maximum

by integrating

Hz)

wiped with a towel

to keep them warm. The

spectral

the

frequency and

were

components

measured

posi-

peaks

of HRV

feet were quickly

and risks of this study

was

were

the

of ECG were

the two frequency

the

using a

before

R-wave

without

foot-bath

ECG

of R-wave

After

the

completing

was

all

For

positions

peaks were determined

of

GW

(Power Macintosh

data, the temporal

detection

to

and analyzed

received

rate was measured

consent

(GWI-625,

Inc.,

method

respiratory

informed

converter

Co., Ltd., Japan).

The

to each subject

digital

Instruments,

analysis

the

of 500 Hz by an analogue

entropy

for

and

by After

from

at a sampling

Comtec

using a Laser Doppler

obtained

back

five subjects

by one without

Nursing

frequency

played digitized

as a control

followed

Suajects

were explained

subject.

foot-bath

the

tape,

in all subjects,

Blood

for

determined

each

essential

1994), was used in this study.

approval

digital

condition

side Ethical

order for

received

known

Water

experienced

of this study

of an aromathera-

1994a;

subject

physiological

to have a relaxing with

solution.

was

tests, first the control

a random

drawing

essential

angustz~liu), a widely used claimed

and each soak

for

of

oil. Lavender

stances for each subject

in

circum-

condition.

measured

purpose

some

comparable

in

indicator

during the foot-bath

to establish

Japan);

conversation

R-R intervals

on the autonomic

response

of general

tape

after

tions

effects of a foot-bath

to compare

order

TEAC,

confirmed,

has

the

minutes

respiratory

started

tion, in which the feet were not soaked,

the

using

was

and then soaks with and without aroma

of autonomic

system

(RD-145T,

using

ratio

analysis of HRV. A second

and

on a digital

demon-

was to investigate

nervous

oil of lavender

for the soak was started at

40°C. Each different

and, as such, is

purpose

(four

Mayer

tion (Pagani et al., 1985). The

2 ml

(i.e.

(Pomeranz

an

soak

oscillations

LFC-HFC

balance,

aroma

to 4 L of hot water in a wash-

was

atropine

the

and quiet room of 21

added

experiment

by

(22-25°C)

in an air-condi-

The

parasympathetic

strated

et al., 1985).

Tests were performed

of essential

BP

recorder recording

All data were

protocols

drops)

0.1 Hz

by BF

function.

of

et al., 1985).

waves) and is modulated

nervous

Study

m2. For

administration

around

the auto-

accompanied

wave were recorded

Data analysis

corre-

system, since HFC is

corresponds

sympathetic

nomic nervous

tioned

(Pomeranz

occurring

HFC

sinus arrhythmia

an

or use of any

drug that could affect

solely by the parasym-

nervous

abolished

compo-

consump-

low-frequency

The

sponds to respiratory

pathetic

spectral

no

had

of disease,

other

two

possible constraints

subjects

that

are

healthy

maximum

number within the resource

analysis of HRV in humans has revealed there

ten

19-21 years of age, was

Sanei, chest.

(EGG)

Surface results

after

5 minutes

after

before

the end

soak. Blood flow was analyzed aging periods

the

Stat&&l Data

value

during

as described

of the by aver-

the

same

above.

ana@& for

individual

subjects

were

grouped

to represent

the control conch-

nuec

tion, the soak with aroma and the soak without aroma. All data are presented mean

(SE). Differences

of baseline,

as

Ejfi;l

~~~

in each period

5 minutes,

10 minutes,

or

after, across groups were assessed by a repeated

measure

followed

by Fisher’s

Significant between

Protected

after

baseline 5 tin

time

Least

test. Differences

IO mn

after

baseline Emi,, lOtin

time

Fig. 1 Changes in R-R interval

after

time

in controls, with foot-bath

and with aromatherapy

foot-bath

mllmid100e 60,

cantml

-

without

60 1

aroma

60 1

and during or after the

soak in each condition by using

baseline 5 min IOmin

analysis of variance

Difference

before

;iI [?

Student’s

were calculated

paired

&test. A P-

value of less than 0.05 was considered statistically significant

zo-

a

baseline 5 min 10 ti

after

201

201 baseline 5 min 10 mm

time

difference.

after

baseline Bti

time

Fig. 2 Changes in blood flow

lOti time

after

*:P
timesknin

There

were

differences

no statistically

in water temperatures

for

at either

the beginning

without

25 I

20 v

the aroma soak and the without aroma soak,

control

25 I

significant

25

??

2o

-++----

2o

aroma

m

I

or the

end of the soak (Table 1). There ences

were no significant

in R-R

respiratory

interval

rate at baseline

three

different

interval

did not change

tions

without aroma,

during aroma.

or

BF showed significant

increase

increased

after starting

condition

with

significantly

remained

from

statistically

BF

34.8

(SE

to decrease

conditions,

(Fig.

3). There

significant

OF

mean

1

Frequency (Hz)

3-I

0

WATER

40.2

without aroma

?? baseline 0

5 min

with aroma

? ?10 min ??after 5 min

0.5 0.3 0.2 0.1

g

0

without aroma

COdi-01

0 -

0.25

0.5

0.75

1

Frequency (Ha)

31

with aroma

Fig. 5 Levels for high fiqueneycomponent (HFC, A) and low-highhpquency component ratio (LFC-HFC, B) of HRV *P
in

but

not

were

no

differences

control

0.4

in

low level. During increased Fig. 4 An example of power spectral analysis of heart rate van’abilir)r (HRV) obtained from one subject during the aroma soak PSD: power spechal density

minutes

and

the aroma soak, HFC LFC

of soaking;

decreased

at 5

this continued

the end of soaking at 10 minutes minutes

to

and 5

after the end of soaking.

Using data from the whole group, these among

Start

1

0.75

(Fig. 2). Respiratory

rate showed a tendency foot-bath

0.5

the soak,

at a high level even after the

significantly

-

after starting the soak and

end of the soak

both

2 0.25

0.6 ,

aroma

‘7.2) to 40.1 (SE 6.2) ml/minute/100 at 5 minutes

3 0

without

in

4

flow significantly

foot-bath

at 10 minutes while

R-R

with

10 min ??after 5 min

5

in all condi-

foot-bath In

0 baseline m 5 min

level among

conditions.

(Fig. 1). Blood

increased

differ-

of ECG, BF, or

parameters the

shows an example spectral

in

three

each

groups.

period Figure

of the changes in the

analysis of HRV obtained

one subject

during 4

during

this case, at baseline

HFC

the control nor

significantly

from

For

the aroma soak. In

condition,

before

soak, LFC

showed high level, while HFC showed

minutes higher

condition

LFC-HFC

ratio

neither changed

(Fig. 5). the the

of

without HFC

soaking

aroma value

soak

after

5

was significantly

than at baseline.

After that, the

HFC value declined ended

and, when the soak

at 10 minutes,

baseline

level.

condition, 0.38)

For

the

aroma

the HFC value

second?

cantly

had returned

seconds2

after

to

the

(SE

5 minutes

difference

(SE

was signifi-

4.2

0.56)

when

higher, the

Contrary interval

more,

soak

remains

unclear.

to the

results

or respiratory

rate,

increased

the

of soaking.

After that, the HFC remained but

soak

of 3.4

at baseline

increased

oils on respiration

to

by the foot-bath

this increase

addition

lavender.

of

These

the foot-bath

10 minute

after oil

indicate

of that

vasodilata-

tion in skin area, probably

by a reduc-

essential via

able that the reduction

minutes

ratio

did

without

not

change

aroma

soak

LFC-HFC during

the

condition

(Fig.

5B). For the aroma soak condition, LFC-HFC

ratio showed

decline

after soaking.

were

no statistical

ratio

between

minutes

baseline

was significantly

bath compared the baseline

to

there in the

and

5 or 10

soak, this value

decreased

0.04) at 5 minutes

to 0.26 (SE

after the end of foot-

with 0.47

(SE 0.08)

of

(Fig. 5B).

There

the LFC-HFC at

for either

all

periods,

10 minutes

control,

the

overall relaxing

secondary

signifi-

analysis

baseline,

5

and after, among

aroma

soak

and

without aroma soak conditions

the

(Fig. 5).

in

the

although

that the foot-bath

to induce

autonomic

nervous

present

and

study

respiratory

significantly

ECG

rate

during

consistent

with that

effect

of

the

199413; Dunn,

of

previous

aromatherapy

1995).

1993)

Buckle

has shown that respira-

postoperative

receiving

massage

statistical

analysis

and, therefore,

not

rate (Stevensen, Although

with

the effect

for 20 patients

essential

was not

can be drawn

oils,

attempted of essential

Stevensen, 1994).

performed

for

in the

present

et al.21

25%

of

1994a; The footonly

study.

reported

an

fragrance

10

Since

that only

applied

dose

of

penetrated

human

skin in 12 hours, it is doubtful

whether

sufficient

essential

oil is absorbed

via

from this study in which body tempera-

the present

of essen-

ture was not measured,

tial oils are thought

seems

to increase

tion

and,

furthermore,

use of the essential

this

even without This

nerve

soaking

that

ratio did not during

nerve

activity

appears not to be affected the

aroma

continued

did not

reach

elevated although

statistical

LFC-HFC

progressively,

significance

after

relaxing

the

results

condition

thetic

effects

of lavender

suggest

that the

may continue

was about

the concentration in

the

even due to

study, the room was carried

21 m* in extent.

air

was not seemed

to influence

autonomic

nervous

Some

studies

effect

1994b; reason

(Buckle,

for

differences

previous

BF result in this study.

the

results and

the

present one may be related to the sensitivity of the physiological

parameters.

In these previous studies, the change in HR or BP was used as the physiological parameter.

Kamada

et al. (1992)

by LFC-HFC

obtained

possible

in

studies

balance

results

Stevensen

One

sympathetic

analysis support

that

beneficial

1994;

1995).

and the decreased The

shown

about

effect but not physiolog-

Dunn,

between

have

brings

finding changes

activities.

system

function.

reported

the spectral

the

to be sufficient

parasympa-

nerve

fragrance

measured,

of increased

from

out

Although

of volatile

concentration

ical

had

system might

from the hot

even

reaching

foot-bath

after the end of the foot-bath the

nervous

oil after it has evaporated

psychological

ratio

1992).

be the result of inhalation

HFC

this

limbic

(Buckle,

it is likely that the effect on

aromatherapy

significance.

decreased

These

greatly.

condition,

to be

the

Furthermore,

in

system.

change

sympathetic

For

effect

nervous

any significant

soaking,

Therefore,

where the experiment

foot-bath

and

systems after inhalation

water. In the present

of lavender

to be most rapid

olfactory

significantly

the

However, since LFC-HFC

ended.

activity, as

a relaxing

autonomic

the

in hot water

the addition

suggests

through

study. The effects

the autonomic

by the HFC value in spectral

after 5 minutes’

show

effect

by the additional

analysis of HRV, increased

oil.

circula-

oil.

Parasympathetic reflected

the foot-bath

peripheral

after the end of soaking,

such as

of body

1994;

Bronaugh

volatile

Sandersen

and Booth,

was

about a

foot-bath.

no conclusions

level

slower and deeper

24

a rise

change

studies

merely

following

with or

did

parameters

BP, HR or respiratory

out

did not

be

1992;

1990;

system in

interval

oil. This finding is

affect physiological

tion became

R-R

foot-bath

without the essential

(Buckle,

system,

its effect seems to be weak. In

the

showing

a relaxation

of the

(Buckle,

al.,

the skin to affect the nervous

the has a tendency

part

effect during foot-bath.

itself may induce This study suggests

be

it might

temperature Although

of sympathetic

might

Alternatively,

the HFC or

ratio of spectral

minutes,

activity

seems to be promoted

were no statistically

cant differences

values

Although

differences

of the aroma

the

a tendency

nerve

or the respira-

Carter,

bath

The

et al, 1990)

and

vating skin blood vessels. It seems prob-

5A).

into the body et

tract

significant

that

(Bronaugh

tory

Trevelyan

for a

It is known

oil is absorbed

Hotchkiss

tion of sympathetic

nerve activity inner-

foot-soak.

skin

ended at 10 minutes was not statistically (Fig.

aromatherapy

tial oil to hot water in a washbasin

essential

might produce

of

BF was

and, further-

results

method

used in this study was to add the essen-

lasted longer the

The

of R-R

ratio

which could not be observed uring HR and BP. Similar shown in the present

have

in autonomic in

HRV

by meas-

trends were

and other studies

(Mukai and Hayano, 1995).

Together,

1995; Sato et al.,

these

that power spectral

studies suggest

analysis of HRV has

greater sensitivity than HR or BP and is a useful

method

to assess autonomic

essential oils, which could not be found in this study on the basis of physiologmeasures

used

only revealed

previously,

by this more

method. The physiological essential

oils appears

the within-group statistical Lack

of

were

sensitive

effect of the

to be weak since

changes did not reach

significance

between

significant

groups.

differences

may

summary,

appears

a

hot

to be a method

parasympathetic related

foot-bath

of increasing

nerve activity, which is

Furthermore,

in the case of the foot-

bath with the addition of essential oil of lavender,

there

were delayed

to the balance

changes

of autonomic

again in the direction

Blamery

aromatherapy

in

activity,

associated

C.

with

relaxation.

Using

childbirth.

Nursing

??

Cannard

G. On the scent of a good

sleep.

Nursing

Standard

1995;

Dale

A, Cornwell in

S. The

lavender

oil

discomfort

following childbirth:

randomized

relieving

clinical

Advanced Nursing ??

an

role

of

perineal

trial. Journal

of

1994; 19: 89-96.

improvement: to

an

experimental

evaluate

the

care unit. Journal

of

function

Advanced

1995; 21: 34-40.

benzyl acetate

through

1. validation

of

against

in

rat skin in vitro.

an

vivo

Chemical

of

in vitro

data.

Toxicology

model

Food

and

1990;

28:

443-447. Hudson

R. Lavender

oil aids relaxNursing

Times

0 White,

is thankful

Nagano

critically

College

reading

to Dr

C.M.

of Nursing

for

the manuscript.

Hudson

R. Use

long-term

of lavender

in a

elderly ward. Nursing Times

1995; 91: 12. 0

Kamada T, Miyake S, Kumashiro

Monou

H,

Inoue

K

Power

M,

spectral

analysis of heart rate variability in Type 0

Bronaugh

Maibach taneous

RL, Wester RC, Bucks D,

HI, Sarason absorption

R. In vivo percuof fragrance

ingre-

dients in rhesus monkeys and humans. Food

and Chemical

Toxicology

1990;

Buchbauer

Dietrich

H,

G, Jirovetz Christine

Aromatherapy: effects

Evidence

of the essential

after inhalation.

Journal

L, Jager

W,

P, Karamat for

E.

sedative

oil of lavender of Biosciences

Buckle

J.

Which

lavender

oil?

Buckle

J.

Aromatherapy.

Times 1993; 89: 32-35.

Nursing

mental

work-

Medicine

1992;

54: 462-470. 0

Lis-Balchin

M.

‘aromatherapy’:

Health ??

Essential

their

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