The effect of foot-bath with or

without the essential oil of

lavender on the autonomic
nervous system:
a randomized trial
Y. Saeki Department of Anatomy and Physiology,Nagano College of
Nursing, Komagane-City,Nagano,Japan

S U M M A R Y . Objectives:This study was designed to investigate the effect of foot-bath

with or without the essential oil of lavender on the autonomic nervous system. Design:
Randomized crossover controlled study. Setting: Nursing college, Nagano, Japan.
Intervention:Young w o m e n sat with their feet soaked in hot w a t e r for I 0 minutes with
and without the essential oil. O u t c o m e measures:An electrocardiogram, finger tip
blood flow and respiratory rate were recorded.Autonomic function was evaluated
using spectral analysis of heart rate variability. Results:The foot-bath caused no
changes in heart or respiratory rates, but produced a significant increase in blood flow.
Using spectral analysis, the parasympathetic nerve activity increased significantly
during the both types of foot-bath. In the case of the foot-bath with the addition of
essential oil of lavender, there were delayed changes to the balance of autonomic
activity in the direction associated with relaxation. Conclusion:A hot foot-bath and oil
of lavender appear to be associated with small but significant changes in autonomic
activity. © 2000 H a r c o u r t Publishers Ltd

INTRODUCTION ies have suggested that aromatherapy may contribute

Yuka Saeki, Department
of Anatomy and Physiology.
Nagano College of
Nursing, 1694Akaho,
Komagane-Gty.Nagano
399-4117,Japan
Foot-bathing is a frequently performed nursing
practice. This procedure can maintain skin integrity
of the foot or maintain foot function. Although it
plays an important role in providing for patients'
comfort and sense of well-being, there is little
research into the general physiological effects of
foot-bathing on the human body.
Aromatherapy has been used in a wide variety of
nursing care settings, especially by nurses as part of
a holistic approach to patients. ~-5 Although aro-
matherapy is generally used to improve quality of
life at both psychological and physiological levels,
so far it seems that very few reports have shown evi-
dence for the efficacy of essential oils. 5 It has been
reported that many plant essential oils have a potent
antibacterial effect in vitro.6 An experiment using
animals demonstrated the sedative effects of the
essential oil of lavender after inhalation. 7 Some stud-
to a good night's sleep in humans, s-"' Other reports
have suggested that essential oils may alleviate anxi-
ety or pain and promote relaxation in humans, z~.~-~
though a controlled trial was negative? -~ Studies
simultaneously investigating psychological and
physiological effects of essential oil in human have
shown that essential oil did not change physiological
parameters such as blood pressure (BP) or heart rate
(HR), but did produce psychological improvement
in mood and anxiety levels. ]~-L~'Thus, although the
essential oils seem likely to produce a beneficial
psychological effect, no physiological effects on the
human body have yet been demonstrated.
Recently, power spectral analysis of heart rate
variability (HRV) has been used to evaluate auto-
nomic nervous system function? 7--'° Power spectral
analysis of HRV in humans has revealed that there
are two major spectral components: a high-
frequency component (HFC) and a low-frequency

Complementary Therapiesin Medicine (2000).8.2-7 © 2000HarcourtPublishersLtd 2

Relaxation by foot-bath with aromatherapy
component (LFC). The HFC corresponds to respira-
tory sinus arrhythmia and is modulated solely by the
parasympathetic nervous system, since HFC is
abolished by an administration of atropine, ts The
LFC corresponds to BP oscillations occurring
around 0.1 Hz (i.e. Mayer waves) and is modulated
jointly by the sympathetic and parasympathetic ner-
vous systems. This was demonstrated by an experi-
ment using atropine and propranolol, ts The
LFC-HFC ratio has been proposed as an indicator of
sympatho-vagal balance, and, as such, is a useful
parameter of autonomic function?7
The main purpose of this study was to investigate
the physiological effects of a foot-bath on the auto-
nomic nervous system using the spectral analysis of
HRV. A second purpose was to compare autonomic
nervous system response during the foot-bath with
and without the addition Of an aromatherapeutic
essential oil. Lavender (Lavender angustifolia), a
widely used oil that is claimed to have a relaxing
and calming effect with no known side-effects, -'.3
was used in this study.
METHODS
Subjects
Ethical approval for the study was obtained from
the Nagano College of Nursing Laboratory
Committee. The nature, purpose, and risks of this
study were explained to each subject before written
informed consent was obtained. A sample of ten
healthy female subjects, 19-21 years of age, was
chosen as the maximum possible number within the
resource constraints of this study. The subjects had
no current history of disease, consumption of alco-
hol or tobacco, or use of any other drug that could
affect the autonomic nervous function.
Study protocols
Tests were performed in an air-conditioned
(22-25°C) and quiet room of 21 m-'. For the aroma
soak 2 ml (four drops) of essential oil of lavender
was added to 4 L of hot water in a washbasin, giving
a 0.05% solution. Water temperature for the soak
was started at 40°C. Each subject experienced three
different tests, fin'st the control condition, in which
the feet were not soaked, and then soaks with and
without aroma in a random order determined by
drawing lots for each, subject. After sitting for 10
minutes as a control condition in all subjects, five
subjects received the foot-bath without the essential
oil followed by one with the essential oil. The other
five subjects received foot-bath with the essential
oil followed by one without it. Each soak lasted 10
minutes. After soaking, the feet were quickly wiped
with a towel and then wrapped in a dry bath towel to
keep them warm. The second soak occurred at least
60 minutes after completion of data collection for
the first soak. Data were collected for 20 minutes
continuously for each subject for each condition,
from 3 minutes before beginning to 7 minutes after
completing the soak.
Blood flow (BF) of the palmar side of the finger-
tip was measured using a Laser Doppler flowmeter
(ALF 21, Advance Co. LTD., Japan). The subjects
breathed spontaneously and respiratory rate was
measured using a respiratory band (NEC Sanei,
Japan) wrapped around the chest. Surface electro-
cardiogram (ECG) results accompanied by BF and
respiratory wave were recorded on a digital tape
recorder (RD-145T, TEAC, Japan); recording was
started after some minutes of general conversation
in order to establish comparable circumstances for
each subject and each soak condition.
Data analysis
All data were played back from the digital tape,
digitized at a sampling frequency of 500 Hz by an
analogue to digital converter (GWI-625, GW
Instruments, Inc., UK.), and analyzed on a micro-
computer (Power Macintosh 7100/80AV, Apple,
Japan). For ECG data, the temporal positions of R-
wave peaks were determined by a fast-peak detec-
tion algorithm. After the positions of all R-wave
peaks were confirmed, R-R intervals of ECG were
measured for HRV. The spectral analysis of HRV
used the maximum entropy method (Hyper Wave,
Kissei Comtec Co., Ltd., Japan). The area of the
two frequency components of HRV were measured
by integrating low-frequency component (LFC,
0.02-0.15Hz) and high-frequency component
(HFC, 0.15-0.40 Hz). The LFC to HFC ratio of
HRV was also calculated (LFC-HFC). For control
or each soak condition, data for 2 minute periods
out of each 20 minute recording were selected as
follows: baseline - the middle period of 2 minutes
of the 3 minutes recorded before the soak; 5 min-
utes - period of 2 minutes before and after 5 min-
utes after the start of the soak; 10 minutes - period
of 2 minutes immediately before the feet were
removed from the foot-bath; and a f t e r - period of 2
minutes before and after 5 minutes after the end of
the soak. Blood flow was analyzed by averaging
the value during the same periods as described
above.
Statistical analysis
Data for individual subjects were grouped to repre-
sent the control condition, the soak with aroma and
the soak without aroma. All data are presented fis
mean (SE). Differences in each period of baseline, 5
minutes, 10 minutes, or after, across groups were
assessed by a repeated measure analysis of variance
followed by Fisher's Protected Least Significant
Difference test. Differences between before and
during or after the soak in each condition were cal-
culated by using Student's paired t-testT.A P-value
4 ComplementaryTherapies in Medicine

o f less than 0.05 was considered a statistically sig-
nificant difference.
RESULTS
There were no statistically significant differences in
water temperatures for the aroma soak and the with-
out aroma soak, at either the beginning or the end of
the soak (Table 1).
There were no significant differences in R-R
interval of ECG, BF, or respiratory rate at baseline
level among three different conditions. R-R interval
did not change in all conditions (Fig. 1). Blood flow
significantly increased during foot-bath with or
without aroma. In foot-bath without aroma, BF
showed significant increase at 10 minutes after
starting the soak, while in condition with aroma BF
increased significantly from 34.8 (SE 7.2) to 40.1
(SE 6.2) ml/minute/100 g at 5 minutes after starting
the soak and remained at a high level even after the
end of the soak (Fig. 2). Respiratory rate showed a
tendency to decrease in both foot-bath conditions,
but not significantly (Fig. 3). There were no statisti-
cally significant differences in these parameters in
each period among the three groups. Figure 4 shows
an example of the changes in the spectral analysis of
W i t h o u t aroma W i t h aroma
Start mean 40.2 40.2
SE 0.08 O. 18
End mean 37.5 37.0
SE 0.26 O. I I
HRV obtained from one subject during the aroma
soak. In this case, at baseline before soak, LFC
showed high level, while HFC showed low level.
During the aroma soak, HFC increased and LFC
decreased at 5 minutes of soaking; this continued to
the end of soaking at 10 minutes and 5 minutes after
the end of soaking.
Using data from the whole group, during the
control condition neither HFC nor LFC-HFC ratio
changed significantly (Fig. 5).
For the without aroma soak condition, the HFC
value after 5 minutes of soaking was significantly
higher than at baseline. After that, the HFC value
declined and, when the soak ended at l0 minutes,
had returned to baseline level. For the aroma soak
condition, the HFC value of 3.4 (SE 0.38) seconds:
at baseline was significantly increased to 4.2 (SE
0.56) seconds-' after 5 minutes of soaking. After
that, the HFC remained higher, but the difference
when the soak ended at l0 minutes was not statisti-
cally significant (Fig. 5A). The LFC-HFC ratio did
not change during the without aroma soak condition
(Fig. 5B). For the aroma soak condition, the
LFC-HFC ratio showed a tendency to decline after
soaking. Although there were no statistical differ-
ences in the ratio between baseline and 5 or 10 min-
utes of the aroma soak, this value was significantly
decreased to 0.26 (SE 0.04) at 5 minutes after the
end of foot-bath compared with 0.47 (SE 0.08) of
the baseline (Fig. 5B).
There were no statistically significant differ-
ences for either the HFC or the LFC-HFC ratio of
spectral analysis values at all periods, baseline, 5
minutes, 10 minutes and after, anmng control, the
aroma soak and the without aroma soak conditions
(Fig. 5).

msec
900' 900 900'
control without aroma

850" 850 850"

800"

750'
800

750
~ _ ~ 800-

750.

70O , 700 , 700

baseline 5 min 10 min after baseline 5 min 10 min after baseline 5 rain I0 min after
time time time

Fig. I Changes in R-R interval in controls, with foot-bath and with aromatherapy foot-bath

mYmin]lOOg
60
50
40
30 •
control
50
40
30
60150
40
30
20 i E i 20 i , 20 i i i

baseline 5 rain 10 min after baseline5 rain 10 min at~r baseline 5 min 10 min after
time time time

Fig. 2 Changes in blood flow ":P<0.05 vs. baseline

Relaxation by foot-bath with aromatherapy 5

times/min
without 25 aroma
2025t ~ control 25
20
20

15 , , 15 i i 15 , ! | |

baseline 5 •in 10 min after baseline 5 •in 10 min after baseline 5 min 10 rain after
time time time

Fig.3 Changes in respiratory rate

baseline
A
61 Obaseline [] 5min • 10min • after5min
/ •

t~

r.D

0 0.25 0.5 0.;75

3 Frequency (Hz)
5 min control without aroma with aroma

1:3baseline 13 5 min [] 10 min • after 5 min

i

0 0.25 0.5 0.75 '~015

i ~ Frequency (Hz) ~ 0.4
10 • i n ~ 0.3
0.2
~0.1
0 "' , ,

control without aroma with aroma

Fig. 5 Levels for high frequency component (HFC, A) and
0 0.25 0.5 0.75 1
low-high frequency component ratio (LFC-HFC. B) of HRV
3 Frequency (Hz) *P<0.05 vs. baseline.

~ 2 1 ~ after
~ 0
0 0.25 0.5 0.75
Freouencv IHz)
Fig. 4 An example of power spectral analysisof heart rate
variability (HRV)obtained from one subject during the aroma
soak PSI:3:power spectral density
DISCUSSION
This study suggests that the foot-bath has a ten-
dency to induce a relaxation in the autonomic ner-
vous system, although its effect seems to be weak.
In the present study ECG R-R interval and respira-
tory rate did not change significantly during foot-
bath with or without the essential oil. This finding is
consistent with the previous studies showing that
aromatherapy did not affect physiological parame-
ters such as BP, HR or respiratory rate. L~'~6Although
Buckle ~4 has shown that respiration became slower
and deeper for 20 out of 24 postoperative patients
receiving massage with essential oils, statistical
analysis was not attempted and, therefore, the effect
of essential oils on respiration remains unclear.
Contrary to the results of R-R interval or respira-
tory rate, BF was increased by the foot-bath and,
, furthermore, this increase lasted longer after the
1 addition of the essential oil of lavender. These
results indicate that the foot-bath might produce
vasodilatation in skin area, probably by a reduction
of sympathetic nerve activity innervating skin blood
vessels. It seems probable that the reduction of sym-
pathetic nerve activity might be part of the overall
relaxing effect during foot-bath. Alternatively, it
might be merely a secondary effect of a rise of body
temperature following foot-bath. Although no con-
clusions can be drawn from this study in which
body temperature was not measured, the foot-bath
seems to increase peripheral circulation and, fur-
thermore, this effect seems to be promoted by the
additional use of the essential oil.
Parasympathetic nerve activity, as reflected by
the HFC value in spectral analysis of HILV,
increased significantly after 5 minutes' soaking in
hot water even without the addition of lavender oil.
This suggests that the foot-bath itself may induce a
relaxing effect in the autonomic nervous system.
However, since LFC-HFC ratio did not show any
significant change during soaking, sympathetic
nerve activity appears not to be affected greatly.
6 Complementary Therapies in Medicine
For the aroma condition, HFC level continued to
be elevated even after the end of soaking, although
this did not reach statistical significance.
Furthermore, the L F C - H F C ratio decreased pro-
gressively, reaching significance after the foot-bath
had ended. These results suggest that the relaxing
condition may continue even after the end of the
foot-bath due to the effects of increased parasympa-
thetic and the decreased sympathetic nerve activi-
ties. The results obtained from the spectral analysis
support the B F result in this study.
The method of aromatherapy used in this study
was to add the essential oil to hot water in a wash-
basin for a I0 minute foot-soak. It is k n o w n that
essential oil is absorbed into the body via skin -'~'-~-'or
the respiratory tract2 -3--~3 The foot-bath was per-
formed for only 10 minutes in the present study.
Since B r o n a u g h et al.Zl reported that only about
25% of an applied dose of volatile fragrance pene-
trated h u m a n skin in 12 hours, it is doubtful whether
sufficient essential oil is absorbed via the skin to
affect the nervous system in the present study. The
effects of essential oils are thought to be most rapid
through the olfactory and limbic systems after
inhalation. 23 Therefore, it is likely that the effect on
the autonomic nervous system might be the result of
inhalation of lavender oil after it has evaporated
from the hot water. In the present study, the room
where the experiment was carried out was about 21
m-' in extent. Although the concentration of volatile
fragrance in the air was not measured, the concen-
tration seemed to be sufficient to influence auto-
nomic nervous system function.
Some studies have shown that aromatherapy
brings about beneficial psychological effect but not
physiological effectJ 4-~' One possible reason for
differences in results between previous studies 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._~4 have
reported finding changes in autonomic balance by
L F C - H F C ratio in HRV which could not be
observed by measuring HR and BP. Similar trends
were s h o w n in the present and other studies. -'-~'-~
Together, these studies suggest that power spectral
analysis of HRV has greater sensitivity than HR or
BP and is a useful method to assess autonomic ner-
vous activity. Thus, the effect of the essential oils,
which could not be found in this study on the basis
of physiological measures used previously, were
only revealed by this more sensitive method. The
physiological effect of the essential oils appears to
be weak since the within-group changes did not
reach statistical significance between groups. Lack
of significant differences may relate to small sample
size.
In summary, a hot foot-bath appears to be a
method of increasing parasympathetic nerve activ-
it3,, which is related to physical relaxation.
Furthermore, in the case of the foot-bath with the
addition of essential oil of lavender, there were
delayed changes to the balance of autonomic activ-
ity, again in the direction associated with relaxation.
ACKNOWLEDGEMENT
The author is thankful to Dr C.M. White, Nagano College of
Nursing for critically reading the manuscript.
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