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Journal of Exercise Physiologyonline
February 2014
Volume 17 Number 1
Editor-in-Chief
Official Research Journal of
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Todd Astorino, PhD
Julien Baker,
ISSN 1097-9751
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Official Research Journal
of the American Society of
Exercise Physiologists
ISSN 1097-9751
JEPonline
The Cardiovascular Effects of Lying Supine on a
Vibrating Massage Mat
Ryan Matthew Heilman1, William T. Boone2
1Richland
Medical Center, Richland Center, WI, 53581 2Department
of Health and Kinesiology, Lamar University, Beaumont, TX 77705
ABSTRACT
Heilman RM, Boone WT. The Cardiovascular Effects of Lying Supine
on a Vibrating Massage Mat. JEPonline 2014;17(1):97-104. The aim
of this study was to determine if lying supine on a vibrating massage
mat could induce relaxation expressed through the cardiovascular
system. Twelve subjects (8 female, 4 male) were used in an ABA
design: (a) 10 min of lying on the mat when it was off (Control #1); 10
min of lying on the mat while it was activated (Treatment); and (c) an
additional 10 min of lying on the mat when it was turned off (Control
#2). The following cardiovascular variables were examined: Oxygen
uptake, cardiac output, stroke volume, heart rate, arteriovenous
oxygen difference, systolic blood pressure, diastolic blood pressure,
mean arterial pressure, systemic vascular resistance, myocardial
oxygen consumption, carbon dioxide produced, expired ventilation,
frequency of breath, and tidal volume. A repeated measures ANOVA
was used to compare the three sessions with significance set at the
P≤0.05 level. The Fisher’s least significant difference procedure was
used when significance existed in a variable to determine which
sessions were different. Heart rate was found to be significantly higher
while mean arterial pressure significantly decreased in the treatment
compared to the two controls. Even though there was a difference (1
beat·min-1 and 2 mmHg, respectively), it was concluded that there is
no practical value from either of the changes. Thu, the results suggest
that lying supine on a vibrating massage mat does not provide a
relaxation response on a physiological level.
Key Words: Cardiovascular Responses, Vibrating Massage
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INTRODUCTION
Massage is currently a very common practice with its origin dating back thousands of years and has
even been cited by Hippocrates (15). It is used to relax the body and reduce stress on a physical and
psychological level. Massage has also been used to treat chronic pain, anxiety, chronic fatigue
syndrome, sprains and muscle strains, and severe headaches (2).
This overall concept of massage as a complementary treatment is thought to be greatly beneficial to
promoting health and well-being. The healthcare field uses massage to treat illnesses and other
conditions in which pharmaceutical intervention may not be the only solution. In fact, it is increasing
common to find that medical centers throughout the United States are using alternative treatments
including massage.
According to a survey by Eisenberg et al. (14), there is evidence to show an increase in massage as
an alternative treatment. Their work suggests that individuals believe massage is beneficial to clients
in conjunction with their traditional treatment. The same researchers also found that the total out-ofpocket expenditures on alternative treatment in 1997 were estimated at $27 billion. By comparison,
in 2007, 38 million adults made an estimated 354 million visits to CAM practitioners at an estimated
cost of almost $12 billion dollars (22).
As of now, the methods of massage that are used for therapeutic effects or for inducing relaxation are
through manual techniques such as the Swedish massage (10). Another type of massage that may
be just as common is with vibrating mechanical devices such as chairs or mats. The latter can be
found at various retail chains and public malls. These products are advertised to produce the same
relaxation benefits as hand techniques. However, at the present time, there is little to no physiological
data to support the claims.
Vibration as a form of exercise is relatively a new idea, especially in regards to enhancing fitness or
treating certain medical conditions. Delecluse et al. (13) found increases in knee extensor strength
after 12 wks of performing exercises while standing on a vibrating platform. Blottner et al. (5) showed
that vibration exercise can maintain muscle strength in the lower limbs after 55 days of bed rest. In a
review by Cardinale and Wakeling (11), it was hypothesized that vibration decreases the viscosity of
blood. In turn, the speed of the blood through the vasculature is expected to increase, thus providing
a cardiovascular benefit. Obviously, more research on vibration is necessary to determine the extent
of the health benefits.
There is also the concern of whether vibration has a negative effect on the body. One such
contraindication involved a case of nephrolithiasis, which is the forming of a kidney stone (20). Even
though everyone who plans to be tested with vibrating mechanical devices should read an informed
consent prior to starting, it is always possible that an underlying medical condition exists that may be
exacerbated by vibration. While the potential for negative side-effects resulting from a vibration
session exists, most healthcare professionals and individuals receiving the treatment believe that it is
safe (18).
While there has been much research published that analyzes the effects of hand massage, only a few
scientific articles support the use of a vibrating massage mat to produce a relaxation effect. This
study will help to determine if the vibrating massage mat produces relaxation on a physiological level.
It will also help to determine if the mat is beneficial for individuals with hypertension. If there are no
statistically significant physiologic changes observed, it may be better to consider other methods of
99
relaxing. Thus, the purpose of this study is to determine the cardiovascular responses to lying on a
vibrating mat that is reported to produce a relaxation response.
METHODS
Subjects
Twelve subjects (4 male, 8 female) volunteered to participate in this study. Their characteristics are
presented in Table 1. All subjects read and signed an informed consent prior to data collection. This
study was approved by the Human Subjects Review Board.
Table 1. Descriptive Characteristics of the Subjects (mean ± SD).
Age (yrs)
Height (in)
Weight (lbs)
Women
(n = 8)
Men
(n = 4)
Group Total
(n = 12)
23 ± 1.2
67.2 ± 2.7
152 ± 14.1
23.2 ± 1.2
70.2 ± 1.2
156 ± 19.9
23 ± 1.1
67.2 ± 2.7
152.0 ± 14.1
Research Design
This study was structured as a basic ABA design. The subjects were instructed to lie down on the mat
in a full supine position (face upward) for 10 min. The massage mat was then turned on at the 10thmin as the subjects remained on the mat for another 10-min period. After the Treatment period, the
massage mat turned off at the 20th-min. The subjects remained in the supine position for an
additional 10 min. All subjects were instructed to not perform any strenuous physical activity 12 hrs
prior to testing and to not sleep throughout the 30 min of continuous testing. An electric, vibrating
massage mat, placed on top of a table was used as the treatment. Oxygen consumption (VO2),
volume of carbon dioxide produce (VCO2), expired ventilation (VE), frequency of breaths (Fb), and
tidal volume (TV) were determined by a MedGraphics CardiO2 metabolic analyzer. Heart rate was
measured by using a Timex HR monitor. Systolic blood pressure (SBP) and diastolic blood pressure
(DBP) were measured through auscultation using a calibrated sphygmomanometer and stethoscope
over the left brachial artery. Cardiac output (Q) was determined using the CO2 rebreathing procedure
in accordance with the Collier method (12). Each subject was instructed how to properly perform the
procedure before testing began.
Data Collection
Heart rate (HR) was measured each minute for the last 5 min of each 10-min period and then
averaged. Blood pressure was measured at minute 8, at minute 18, and at minute 28. Cardiac output
(Q) was measured at the end of each 10-min period. Oxygen consumption, VCO2, VE, Fb, and Tv,
were measured with the MedGraphics CardiO2 metabolic analyzer, which provided 30-sec averages
of these variables. These values were then averaged for the last 5 min of each 10-min period. All
other variables: Stroke volume (SV), arteriovenous oxygen difference (a-vO2 diff), myocardial oxygen
consumption (MVO2), systemic vascular resistance (SVR), and mean arterial pressure (MAP) were
calculated using physiological formulae.
Statistical Analysis
A repeated measures ANOVA (SPSS version 16) was performed to compare the subjects’ responses
during Control #1, Treatment, and Control #2. Fisher’s least significant difference (LSD) procedure
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was used to determine differences in paired groups with significant F-ratios. Statistical significance
was taken at the P<0.05 level.
RESULTS
The results for this study are presented in Table 2. A total of 12 subjects were used (8 female, 4
male) during the data collection process. Each subject assumed the supine position on an automated
massage mat for a total of 30 min. The Treatment (i.e., the vibration period) took place during the
11th through the 20th-min. Minutes 1 through 10 and 21 through 30 served as the before and after
Control #1 and Control #2 periods, respectively. The vibration mat administered vibrations through
small motors at the neck, waist, and knee level. Each subject served as his or her own control.
Significance was found in HR and MAP between Control #1 and Treatment and the Treatment and
Control #2. There were no statistical differences found between Control #1, Treatment, and Control
#2 in VO2, Q, SV, a-vO2 diff, SBP, DBP, MVO2, SVR, VCO2, VE, Tv, and Fb.
Table 2. Cardiovascular Responses to 10 min of Vibration (mean ± SD).
Variables
Control #1
Treatment
Control #2
F-ratio
Prob
VO2 (mL·kg-1·min-1)
3.5 ± .39
3.4 ± .44
3.3 ± .45
1.593
.229
VO2 (L·min-1)
.24 ± .04
.23 ± .04
.23 ± .04
1.568
.231
Q (L·min-1)
3.9 ± 1.1
3.5 ± 1.3
3.5 ± 1.0
1.921
.170
HR (beats·min-1)
62 ± 11
A-B#
63 ± 10
B-C#
62 ± 9
4.237
.028*
SV (mL·bt-1)
65 ± 23
56 ± 24
58 ± 22
2.160
.139
64.6 ± 15.0
73.3 ± 18.5
70.2 ± 15.0
1.681
.209
a-vO2 diff (mL·L-1)
SBP (mmHg)
101 ± 9
100 ± 8
103 ± 8
2.099
.146
DBP (mmHg)
68 ± 7
66 ± 7
68 ± 6
3.018
.069
MAP (mmHg)
79 ± 7
A-B#
77 ± 7
B-C#
79 ± 6
4.929
.017*
2.4 ± 1.7
2.7 ± 1.4
2.6 ± 1.5
1.156
.333
21 ± 6
25 ± 8
25 ± 8
2.793
.083
.23 ± .05
.23 ± .04
.22 ± .04
2.390
.115
VE (L·min-1)
8±1
8±1
8±1
.077
.926
Tv (mL·br-1)
627 ± 191
651 ± 188
656 ± 186
.374
.374
13 ± 3
14 ± 4
13 ± 4
.948
.403
MVO2 (mL·100 g LV·min-1)
SVR (mmHg·L·min-1)
VCO2 (L·min-1)
Fb (breaths·min-1)
*P≤0.05
#Significance between groups
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DISCUSSION
The current study demonstrates that automated massage by a vibrating device while in the supine
position did not produce any cardiovascular responses that would indicate that the subjects were
more relaxed during the vibration (Treatment) period versus the two Control periods. There were
significant differences in HR and MAP, but the size of the differences does not merit practical value.
Specifically, VO2, in either absolute or relative values, did not change across the three periods. This
indicates that the 10-min period of vibration did not bring about a state of relaxation in the subjects.
That is, the subjects did not expend less energy during the vibration period compared to just lying on
the mat. This agrees with previous studies that found no differences in other treatment conditions
thought to induce relaxation (6,7).
However, the present findings do disagree with Boone et al. (8) who observed a decrease in VO2
following massage as well as Benson et al. (4) and Beary et al. (3) who observed a decrease in the
same variable during exercise and rest while eliciting a practiced relaxation response. The different
results may partly be explained by the different methods used in each study and, most importantly,
how the treatment was administered. This is further observed with cardiovascular variables such as
Q, which can be divided into its central (HR and SV) and peripheral (a-vO2 diff) components. Since
VO2 did not increase, and since VO2 and Q are linearly related, it would be expected that Q would not
change. However, it is possible that there could be a change in either the central components or the
peripheral component while VO2 remains the same. As it turned out, vibration had no effect on the
subjects’ SV or a-vO2 diff. The subjects’ HR response during the vibration period was significantly
increased (1 beat·min-1 in the Treatment period vs. the Control periods), but it has no physiological or
practical value. Boone et al. (6) and Boone et al. (8) also found somewhat similar results.
Boone et al. (8) found a decrease in Q and SV after a hand massage that was compensated by an
increase in tissue extraction (a-vO2 diff) that kept the subjects’ VO2 response unchanged during the
Treatment period. This supports the conclusion that the subjects were in a neutral state of resting (if
not relaxation) that was apparently induced by the Treatment (i.e., the subjects’ physiological
responses were unchanged from Control #1). It further argues that the vibrating mat is not as
effective as the manual hand techniques (refer to Table 2). The physiologic variable that seems to
have the most discrepancies among relaxation and massage studies is HR. Kaye et al. (16),
Longworth (17), and Meek (19) reported a decrease in HR after administering various hand massage
treatments while studies involving automated massage devices concluded that HR was unchanged,
even though the subjects noted that they felt relaxed after the treatment. The explanation for the
discrepancy is thought to be due to the small sample size of the study (n = 12). This may also be why
there were no statistical changes in HR in the present study because of the small number of subjects.
The subjects’ hemodynamic responses (i.e., SBP and DBP) were not significant. Mean arterial
pressure, on the other hand, decreased during the Treatment period versus both Control periods. The
mean difference of -2 mmHg is actually very similar to the subjects’ HR interpretation (that is, from a
physiological point of view, it has very little to no practical value). Also, the fact that subjects’ SBP and
DBP responses did not change is reasonable, given that Q and SVR remained the same as well. This
finding appears to differ with that of Peters et al. (22) who reported relaxation decreased blood
pressure. However, their subjects engaged in 12 wks of relaxation versus a one 10-min relaxation
period by vibration.
Then, too, there is always the possibility that even with more time during the Treatment period the
vibration mat would still have failed to produce significant changes in the subjects’ blood pressure.
This was apparently the case with Boone et al. (8) who showed no significance in SBP after just 10-
102
min of massage. In contrast, several studies (1,16,17,19) reported a decrease in the subjects’ SBP
response to acute and chronic massage. In fact, Sok So et al. (24) reported a large decrease in SBP
using a massage mat. The subjects were middle-aged to elderly with hypertension, which may have
allowed for the large change. By comparison the subjects in the present study were normotensive.
This would tend to make any change in blood pressure somewhat more difficult to realize as the
potential to lower blood pressure in a subject who is hypertensive is greater than one who is not.
Perhaps, therefore, the use of a vibrating massage mat may have a marked effect of lowering blood
pressure in hypertensive individuals while not producing similar responses in normotensive
individuals. It may also be the fact that the subjects in the present study did not appear to express
anxiety or high levels of stress that might have influenced the outcome.
The subjects’ MVO2 and SVR responses did not change during the Treatment period. This response
is understandable, given that SBP was not changed and the HR response (i.e., increase) was actually
too small to have any value. Therefore, MVO2, which was calculated as DP (SBP x HR x .01) times
.14 minus 6.3, did not change. This means the subjects’ heart during the vibration period required no
more or no less oxygen than during the two Controls periods. Had the vibration resulted in relaxation
of the subjects, MVO2 would have been expected to decrease in accordance with an overall decrease
in HR, SBP, and VO2. In this case, since none of these responses was statistically decreased, the
anticipated finding that the subjects were relaxed during the vibration period did not occur. In effect
then, since MVO2 generally reflects the total body’s need for oxygen, no change in VO 2 would then be
consistent with no change in MVO2.
Relaxation is typically associated with a decrease in SVR, thus allowing for blood to flow to the
tissues with greater ease. Had the vibration period resulted in the relaxation of the subjects, SVR
would have decreased. However, since SVR did not decrease, along with the other physiological
responses, again, it is the finding of this study that vibration did not produce relaxation. This point is
consistent with the non-physiologically significant changes in the subjects’ MAP and Q during the
vibration period.
The respiratory values also revealed that the vibration period did not cause any changes in T v, Fb,
and VE. This is supported by the fact that there was no increased need for oxygen as shown by the
results of the subjects’ VO2 across the three periods. These findings disagree with the data of Beary
et al. (3). They found a decrease in Fb in their subjects, along with a decrease in VO2 after a
relaxation session. Boone et al. (8) reported an increase in VE after massage. The fact that they did
not report Fb makes the comparison to Beary et al. (3) not as clear as to whether it was due to Fb or
Tv. Regardless of the subjects’ responses to relaxation, a decrease in the need for oxygen decreases
the body’s need to take more in and thus allows for less work at the lungs (V E). The degree to which
VE is changed as a function of Fb or Tv is still an interesting research question.
CONCLUSIONS
This study evaluated the cardiovascular responses during a 10-min period while in the supine
position. It is clear that the vibration mat did not produce a physiologically relaxed response in the
healthy college-aged subjects.
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Address for correspondence: Heilman RM, DPT, 1376 Highland Village Dr. #21, Duluth, MN, USA,
55811, Email: rheilman@css.edu
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