Effect of Hand and Foot Massage Therapy on Psychological Factors and EEG Activity in Elderly People Requiring Long-Term Care: A Randomized Cross-Over Study.

brain sciences Article Effect of Hand and Foot Massage Therapy on Psychological Factors and EEG Activity in Elderly People Requiring Long-Term Care: A Randomized Cross-Over Study Hideki Nakano 1, *, Takayuki Kodama 1 , Tomohiro Ueda 2 , Ikuko Mori 3,4 , Tomiko Tani 3,4 and Shin Murata 1 1 2 3 4 * Department of Physical Therapy, Faculty of Health Science, Kyoto Tachibana University, Kyoto 607-8175, Japan; (T.K.); (S.M.) Graduate School of Health Science, Kyoto Tachibana University, Kyoto 607-8175, Japan; Naris Cosmetics Company Limited, Osaka 553-0001, Japan; (I.M.); (T.T.) Japan Wellness Therapist Association, Osaka 553-0001, Japan Correspondence: ; Tel.: +81-75-571-1111 Received: 11 January 2019; Accepted: 28 February 2019; Published: 4 March 2019



 Abstract: Massage therapy is widely used as a complementary therapy in the elderly. Here, we investigate the effect of hand and foot massage therapy on psychological factors and electroencephalographic (EEG) activity in elderly people requiring long-term care. We included 12 elderly people requiring long-term care, who were randomly divided into two groups (A and B). Group A received hand massage and group B received foot massage, both for 15 min each. After 1 week, group A received foot massage and group B received hand massage, both for 15 min each. We assessed emotions and mood states with a Likert scale after each massage and resting-state EEG activity was measured before and after each massage. Our results showed that both hand and foot massage led to a high degree of pleasant, relaxed, and refreshed feelings. Moreover, resting-state alpha activity significantly increased in the left insular cortex after hand massage (p < 0.05), and in the right and left posterior cingulate cortex after foot massage (p < 0.05). This study suggests that hand and foot massage therapy modulate psychological factors and EEG activity in elderly people requiring long-term care. Keywords: massage therapy; elderly people; emotion; mood; EEG 1. Introduction Massage therapy is a widely-used complementary and alternative therapy for elderly people [1–3]. The American Massage Therapy Association defines massage as “manual soft tissue manipulation, including holding, causing movement, and/or applying pressure to the body” [4]. It is reported that massage therapy effectively improves the health and well-being of elderly people, which may be important as the elderly population increases in various countries worldwide [5]. In a study examining the effect of massage therapy on the elderly, Sharpe et al. [6] demonstrated that massage therapy enhances well-being and reduces stress perception among elderly people. Moreover, Munk et al. [7] reported a relationship between massage therapy and health outcomes in the elderly. Similarly, Sefton et al. [8,9] have reported that massage therapy improves postural balance and blood pressure in elderly people. Brain Sci. 2019, 9, 54; doi:10.3390/brainsci9030054 www.mdpi.com/journal/brainsci Brain Sci. 2019, 9, 54 2 of 8 Consistent with these positive effects of massage, research investigating the physiological effects of massage therapy with electroencephalography (EEG) has suggested that massage therapy reduces anxiety, increases frontal delta activity, and decreases frontal alpha and beta activity [10]. Jones et al. [11] also reported that massage therapy shifts frontal alpha asymmetry from right-hemisphere dominance to left-hemisphere dominance. Moreover, Diego et al. [12] confirmed these findings, suggesting that massage therapy reduces anxiety and stress, increases frontal delta activity, decreases frontal alpha and beta activity, and shifts frontal alpha asymmetry from right-hemisphere dominance to left-hemisphere dominance. Similarly, our previous study demonstrated that manual massage increases resting-state alpha activity in the left anterior cingulate cortex compared with machine massage [13]. Together, these findings provide evidence that massage therapy effectively improves the health and well-being of the elderly, and that massage therapy acts to modulate EEG activity. However, previous studies have investigated massage therapy on various body parts including the hand [14–20], foot [21,22], and lower back [15,23,24]. The different effects of massage therapy on each body part have, therefore, not been sufficiently clarified. Hence, this study aimed to investigate the effect of hand and foot massage therapy on psychological factors and EEG activity in elderly people requiring long-term care. 2. Materials and Methods 2.1. Participants The population from which the study sample was drawn included 69 elderly people who attended a day service center. We included participants aged 65 years and older, and those with Japanese long-term care insurance (LTCI) services [25]. Elderly people using LTCI services had physical or mental impairment and needed assistance with activities of daily living [26]. We excluded participants with Mini-Mental State Examination (MMSE) scores below 24, and those with orthopedic, neurological, cardiovascular, or psychiatric diseases that might influence the results. Finally, 12 elderly people (female, n = 9; male, n = 3; mean age ± standard deviation: 81.9 ± 3.9 years) were recruited to the study. Recruitment of participants was conducted by a third party, and all those who were approached to participate consented to taking part. The power calculation was performed using G*Power [27,28]. The study was conducted according to the principles of the Declaration of Helsinki and was approved by the local institutional ethics committee of Kyoto Tachibana University. All participants provided informed written consent and were free to withdraw from the study at any time. 2.2. Study Protocol This study was a randomized cross-over study. Initially, participants were randomly divided into two groups (A and B) using random numbers generated by Microsoft Excel 2010 (Microsoft, Redmond, WA, USA). Group A received hand massage and group B received foot massage, both for 15 min each. After 1 week, the body part for massage was changed such that group A received foot massage and group B received hand massage, both for 15 min each. Participants received hand massage while sitting on a chair with a back and armrests. Foot massage was received while in a supine position on a bed. Each massage was performed by two therapists who had worked as instructors at the Japan Wellness Therapist Association for five years. One therapist (female, 65 years old) performed only hand massage and the other (female, 60 years old) performed only foot massage. Fragrance-free massage oil (2E32000, Naris Cosmetics Co., Ltd., Osaka, Japan) was used during each massage to prevent friction and discomfort. A standard massage technique [13], without pressure on points indicated by reflexology [29], was used in this study. Hand massage was performed according to the following procedure. First, th (...truncated)