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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


to a good night's sleep in humans, s-"' Other reports
Foot-bathing is a frequently performed nursing have suggested that essential oils may alleviate anxi-
practice. This procedure can maintain skin integrity ety or pain and promote relaxation in humans, z~.~-~
of the foot or maintain foot function. Although it though a controlled trial was negative? -~ Studies
plays an important role in providing for patients' simultaneously investigating psychological and
comfort and sense of well-being, there is little physiological effects of essential oil in human have
research into the general physiological effects of shown that essential oil did not change physiological
foot-bathing on the human body. parameters such as blood pressure (BP) or heart rate
Aromatherapy has been used in a wide variety of (HR), but did produce psychological improvement
nursing care settings, especially by nurses as part of in mood and anxiety levels. ]~-L~'Thus, although the
a holistic approach to patients. ~-5 Although aro- essential oils seem likely to produce a beneficial
matherapy is generally used to improve quality of psychological effect, no physiological effects on the
life at both psychological and physiological levels, human body have yet been demonstrated.
so far it seems that very few reports have shown evi- Recently, power spectral analysis of heart rate
dence for the efficacy of essential oils. 5 It has been variability (HRV) has been used to evaluate auto-
Yuka Saeki, Department
of Anatomy and Physiology. reported that many plant essential oils have a potent nomic nervous system function? 7--'° Power spectral
Nagano College of antibacterial effect in vitro.6 An experiment using analysis of HRV in humans has revealed that there
Nursing, 1694Akaho,
Komagane-Gty.Nagano animals demonstrated the sedative effects of the are two major spectral components: a high-
399-4117,Japan essential oil of lavender after inhalation. 7 Some stud- 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- the first soak. Data were collected for 20 minutes
tory sinus arrhythmia and is modulated solely by the continuously for each subject for each condition,
parasympathetic nervous system, since HFC is from 3 minutes before beginning to 7 minutes after
abolished by an administration of atropine, ts The completing the soak.
LFC corresponds to BP oscillations occurring Blood flow (BF) of the palmar side of the finger-
around 0.1 Hz (i.e. Mayer waves) and is modulated tip was measured using a Laser Doppler flowmeter
jointly by the sympathetic and parasympathetic ner- (ALF 21, Advance Co. LTD., Japan). The subjects
vous systems. This was demonstrated by an experi- breathed spontaneously and respiratory rate was
ment using atropine and propranolol, ts The measured using a respiratory band (NEC Sanei,
LFC-HFC ratio has been proposed as an indicator of Japan) wrapped around the chest. Surface electro-
sympatho-vagal balance, and, as such, is a useful cardiogram (ECG) results accompanied by BF and
parameter of autonomic function?7 respiratory wave were recorded on a digital tape
The main purpose of this study was to investigate recorder (RD-145T, TEAC, Japan); recording was
the physiological effects of a foot-bath on the auto- started after some minutes of general conversation
nomic nervous system using the spectral analysis of in order to establish comparable circumstances for
HRV. A second purpose was to compare autonomic each subject and each soak condition.
nervous system response during the foot-bath with
and without the addition Of an aromatherapeutic
essential oil. Lavender (Lavender angustifolia), a
Data analysis
widely used oil that is claimed to have a relaxing All data were played back from the digital tape,
and calming effect with no known side-effects, -'.3 digitized at a sampling frequency of 500 Hz by an
was used in this study. analogue to digital converter (GWI-625, GW
Instruments, Inc., UK.), and analyzed on a micro-
computer (Power Macintosh 7100/80AV, Apple,
METHODS Japan). For ECG data, the temporal positions of R-
wave peaks were determined by a fast-peak detec-
Subjects tion algorithm. After the positions of all R-wave
peaks were confirmed, R-R intervals of ECG were
Ethical approval for the study was obtained from
measured for HRV. The spectral analysis of HRV
the Nagano College of Nursing Laboratory
used the maximum entropy method (Hyper Wave,
Committee. The nature, purpose, and risks of this
Kissei Comtec Co., Ltd., Japan). The area of the
study were explained to each subject before written
two frequency components of HRV were measured
informed consent was obtained. A sample of ten
by integrating low-frequency component (LFC,
healthy female subjects, 19-21 years of age, was
0.02-0.15Hz) and high-frequency component
chosen as the maximum possible number within the
(HFC, 0.15-0.40 Hz). The LFC to HFC ratio of
resource constraints of this study. The subjects had
HRV was also calculated (LFC-HFC). For control
no current history of disease, consumption of alco-
or each soak condition, data for 2 minute periods
hol or tobacco, or use of any other drug that could
out of each 20 minute recording were selected as
affect the autonomic nervous function.
follows: baseline - the middle period of 2 minutes
of the 3 minutes recorded before the soak; 5 min-
Study protocols utes - period of 2 minutes before and after 5 min-
utes after the start of the soak; 10 minutes - period
Tests were performed in an air-conditioned of 2 minutes immediately before the feet were
(22-25°C) and quiet room of 21 m-'. For the aroma removed from the foot-bath; and a f t e r - period of 2
soak 2 ml (four drops) of essential oil of lavender minutes before and after 5 minutes after the end of
was added to 4 L of hot water in a washbasin, giving the soak. Blood flow was analyzed by averaging
a 0.05% solution. Water temperature for the soak the value during the same periods as described
was started at 40°C. Each subject experienced three above.
different tests, fin'st the control condition, in which
the feet were not soaked, and then soaks with and
Statistical analysis
without aroma in a random order determined by
drawing lots for each, subject. After sitting for 10 Data for individual subjects were grouped to repre-
minutes as a control condition in all subjects, five sent the control condition, the soak with aroma and
subjects received the foot-bath without the essential the soak without aroma. All data are presented fis
oil followed by one with the essential oil. The other mean (SE). Differences in each period of baseline, 5
five subjects received foot-bath with the essential minutes, 10 minutes, or after, across groups were
oil followed by one without it. Each soak lasted 10 assessed by a repeated measure analysis of variance
minutes. After soaking, the feet were quickly wiped followed by Fisher's Protected Least Significant
with a towel and then wrapped in a dry bath towel to Difference test. Differences between before and
keep them warm. The second soak occurred at least during or after the soak in each condition were cal-
60 minutes after completion of data collection for 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- HRV obtained from one subject during the aroma
nificant difference. 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
RESULTS decreased at 5 minutes of soaking; this continued to
the end of soaking at 10 minutes and 5 minutes after
There were no statistically significant differences in the end of soaking.
water temperatures for the aroma soak and the with- Using data from the whole group, during the
out aroma soak, at either the beginning or the end of control condition neither HFC nor LFC-HFC ratio
the soak (Table 1). changed significantly (Fig. 5).
There were no significant differences in R-R For the without aroma soak condition, the HFC
interval of ECG, BF, or respiratory rate at baseline value after 5 minutes of soaking was significantly
level among three different conditions. R-R interval higher than at baseline. After that, the HFC value
did not change in all conditions (Fig. 1). Blood flow declined and, when the soak ended at l0 minutes,
significantly increased during foot-bath with or had returned to baseline level. For the aroma soak
without aroma. In foot-bath without aroma, BF condition, the HFC value of 3.4 (SE 0.38) seconds:
showed significant increase at 10 minutes after at baseline was significantly increased to 4.2 (SE
starting the soak, while in condition with aroma BF 0.56) seconds-' after 5 minutes of soaking. After
increased significantly from 34.8 (SE 7.2) to 40.1 that, the HFC remained higher, but the difference
(SE 6.2) ml/minute/100 g at 5 minutes after starting when the soak ended at l0 minutes was not statisti-
the soak and remained at a high level even after the cally significant (Fig. 5A). The LFC-HFC ratio did
end of the soak (Fig. 2). Respiratory rate showed a not change during the without aroma soak condition
tendency to decrease in both foot-bath conditions, (Fig. 5B). For the aroma soak condition, the
but not significantly (Fig. 3). There were no statisti- LFC-HFC ratio showed a tendency to decline after
cally significant differences in these parameters in soaking. Although there were no statistical differ-
each period among the three groups. Figure 4 shows ences in the ratio between baseline and 5 or 10 min-
an example of the changes in the spectral analysis of 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-
W i t h o u t aroma W i t h aroma ences for either the HFC or the LFC-HFC ratio of
Start mean 40.2 40.2 spectral analysis values at all periods, baseline, 5
SE 0.08 O. 18 minutes, 10 minutes and after, anmng control, the
End mean 37.5 37.0
SE 0.26 O. I I 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
Contrary to the results of R-R interval or respira-
tory rate, BF was increased by the foot-bath and,
~ 0 , furthermore, this increase lasted longer after the
0 0.25 0.5 0.75 1 addition of the essential oil of lavender. These
Freouencv IHz) results indicate that the foot-bath might produce
Fig. 4 An example of power spectral analysisof heart rate vasodilatation in skin area, probably by a reduction
variability (HRV)obtained from one subject during the aroma of sympathetic nerve activity innervating skin blood
soak PSI:3:power spectral density 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
DISCUSSION might be merely a secondary effect of a rise of body
temperature following foot-bath. Although no con-
This study suggests that the foot-bath has a ten- clusions can be drawn from this study in which
dency to induce a relaxation in the autonomic ner- body temperature was not measured, the foot-bath
vous system, although its effect seems to be weak. seems to increase peripheral circulation and, fur-
In the present study ECG R-R interval and respira- thermore, this effect seems to be promoted by the
tory rate did not change significantly during foot- additional use of the essential oil.
bath with or without the essential oil. This finding is Parasympathetic nerve activity, as reflected by
consistent with the previous studies showing that the HFC value in spectral analysis of HILV,
aromatherapy did not affect physiological parame- increased significantly after 5 minutes' soaking in
ters such as BP, HR or respiratory rate. L~'~6Although hot water even without the addition of lavender oil.
Buckle ~4 has shown that respiration became slower This suggests that the foot-bath itself may induce a
and deeper for 20 out of 24 postoperative patients relaxing effect in the autonomic nervous system.
receiving massage with essential oils, statistical However, since LFC-HFC ratio did not show any
analysis was not attempted and, therefore, the effect significant change during soaking, sympathetic
of essential oils on respiration remains unclear. nerve activity appears not to be affected greatly.
6 Complementary Therapies in Medicine

For the aroma condition, HFC level continued to addition of essential oil of lavender, there were
be elevated even after the end of soaking, although delayed changes to the balance of autonomic activ-
this did not reach statistical significance. ity, again in the direction associated with relaxation.
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 ACKNOWLEDGEMENT
condition may continue even after the end of the
The author is thankful to Dr C.M. White, Nagano College of
foot-bath due to the effects of increased parasympa- Nursing for critically reading the manuscript.
thetic and the decreased sympathetic nerve activi-
ties. The results obtained from the spectral analysis
support the B F result in this study. REFERENCES
The method of aromatherapy used in this study
I. Sanderson H, Carter A. Healing Hands. Nursing Times
was to add the essential oil to hot water in a wash-
1994: 90: 46--48.
basin for a I0 minute foot-soak. It is k n o w n that 2. Stevcnsen C. Aromatherapy: the essentials. Nursing
essential oil is absorbed into the body via skin -'~'-~-'or Standard 1994: 9: RCN Nursing Update 3-8.
the respiratory tract2 -3--~3 The foot-bath was per- 3. Trevelyan F, Booth B. Aromatherapy. Nursing Times
formed for only 10 minutes in the present study. 1994; 90: 3-12.
4. Spurling S, Enhancing care using aromatherapy. British
Since B r o n a u g h et al.Zl reported that only about
Journal of Theatre Nursing 1998; 8: 36-38.
25% of an applied dose of volatile fragrance pene- 5. Lis-Balchin M. Essential oils and 'aromatherapy': their
trated h u m a n skin in 12 hours, it is doubtful whether modern role in healing. Journal of Royal Society Health
sufficient essential oil is absorbed via the skin to 1997; 117: 324-329.
affect the nervous system in the present study. The 6. Lis-Balchin M. Deans S, Hart S. A study of the changes
in the bioactivity of essential oils used singly and as
effects of essential oils are thought to be most rapid
mixtures in aromatherapy. The Journal of Alternative
through the olfactory and limbic systems after and Complementary Medicine 1997; 3: 249-256.
inhalation. 23 Therefore, it is likely that the effect on 7. Buchbauer G, Jirovetz L, Jager W, Dietrich H,
the autonomic nervous system might be the result of Christine P, Karamat E. Aromatherapy: Evidence
inhalation of lavender oil after it has evaporated for sedative effects of the essential oil of lavender
after inhalation. Journal of Biosciences 1991 ; 46:
from the hot water. In the present study, the room
1067-1072.
where the experiment was carried out was about 21 8. Cannard G. On the scent of a good night's sleep.
m-' in extent. Although the concentration of volatile Nursing Standard 1995; 9: 21.
fragrance in the air was not measured, the concen- 9. Hudson R. Lavender oil aids relaxation in older patients.
tration seemed to be sufficient to influence auto- Nursing Times 1994; 90:12.
10. Hudson R. Use o1"lavender in a long-term elderly ward.
nomic nervous system function.
Nursing Times 1995; 91 : 12.
Some studies have shown that aromatherapy I 1. Scott E. Body and Soul. Nursing Standard 1995; 9:
brings about beneficial psychological effect but not 22-23.
physiological effectJ 4-~' One possible reason for 12. Burns E. Blamery C. Using aromatherapy in childbirth.
differences in results between previous studies and Nursing Times 1994; 90: 54-60.
13. Dale A, Cornwell S. The role of lavender oil in relieving
the present one may be related to the sensitivity of
perineal discomfort following childbirth: a blind
the physiological parameters. In these previous randomized clinical trial. Journal of Advanced Nursing
studies, the change in HR or BP was used as the 1994; 19: 89-96.
physiological parameter. Kamada et al._~4 have 14. Buckle J. Aromatherapy. Nursing Times 1993; 89:
reported finding changes in autonomic balance by 32-35.
15. Dunn C, Sleep J, Collett D. Sensing an improvement: an
L F C - H F C ratio in HRV which could not be
experimental study to evaluate the use of aromatherapy,
observed by measuring HR and BP. Similar trends massage and periods of rest in an intensive care unit.
were s h o w n in the present and other studies. -'-~'-~ Journal of Advanced Nursing 1995; 21 : 34-40.
Together, these studies suggest that power spectral 16. Stevensen CJ. The psychophysiological effects of
analysis of HRV has greater sensitivity than HR or aromatherapy massage following cardiac surgery.
Complementary Therapies in Medicine 1994; 2: 27-35.
BP and is a useful method to assess autonomic ner-
17. Pagani M, Lombardi F, Quzzeni Set al. Power spectral
vous activity. Thus, the effect of the essential oils, analysis of heart rate and arterial pressure variabilities as
which could not be found in this study on the basis a marker of sympatho-vagal interaction in man and
of physiological measures used previously, were conscious dog. Circulation Research 1986; 59: 178-193.
only revealed by this more sensitive method. The 18. Pomeranz B, Macaulay RJB. Caudill MA et al.
Assessment of autonomic function in humans by heart
physiological effect of the essential oils appears to
rate spectral analysis. American Journal of Physiology
be weak since the within-group changes did not 1985; 248: HI51-H153.
reach statistical significance between groups. Lack 19. Saeki Y, Atogami F, Takahashi K, Yoshizawa T. Reflex
of significant differences may relate to small sample control of autonomic function induced by posture
size. change during the menstrual cycle. Journal of
Autonomic Nervous System 1997; 66: 69-74.
In summary, a hot foot-bath appears to be a
20. Oka H, Mochio S, Sato K et al. Spectral analyses of
method of increasing parasympathetic nerve activ- R-R interval and systolic blood pressure in diabetic
it3,, which is related to physical relaxation. autonomic neuropathy. Journal of Autonomic Nervous
Furthermore, in the case of the foot-bath with the System 1995; 52:203-211.
Relaxation by foot-bath with aromatherapy

21. Bronaugh RL, Wester RC, Bucks D, Maibach HI, 24. Kamada T, Miyake S, Kumashiro M, Monou H, Inoue
Sarason R. In vivo percutaneous absorption of fragrance K. Power spectral analysis of heart rate variability in
ingredients in rhesus monkeys and humans. Food and Type As and Type Bs during mental workload.
Chemical Toxicology 1990; 28: 369-373. Psychosomatic Medicine 1992; 54: 462--470.
22. Hotchkiss SA, Chidgey MAJ, Rose S, Caldwell J. 25. Sato N, Miyake S, Akatsu J, Kumashiro M. Power
Percutaneous absorption of benzyl acetate through rat spectral analysis of heart rate variability in healthy
skin in vitro. 1. validation of an in vitro model against in young women during the normal menstrual cycle.
vivo data. Food and Chemical Toxicology 1990: 28: Psychosomatic Medicine 1995; 57:331-335.
443-447. 26. Mukai S, Hayano J. Heart rate and blood pressure
23. Buckle J. Which lavender oil'? Nursing Times 1992; 88: variabilities during graded head-up tilt. Journal of
54-55. Applied Physiology 1995: 78: 212-216.