RESEARCH

High blood pressure and

associated symptoms
were reduced by massage
therapy
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

M. Hernandez-Reif, T. Field, J. Krasnegor, H. Theakston,

Z. Hossain, I. Burman
Abstract High blood pressure is associated with elevated anxiety, stress and stress
hormones, hostility, depression and catecholamines. Massage therapy and progressive
muscle relaxation were evaluated as treatments for reducing blood pressure and these
associated symptoms. Adults who had been diagnosed as hypertensive received ten 30
min massage sessions over ve weeks or they were given progressive muscle relaxation
instructions (control group). Sitting diastolic blood pressure decreased after the rst
and last massage therapy sessions and reclining diastolic blood pressure decreased
from the rst to the last day of the study. Although both groups reported less anxiety,
only the massage therapy group reported less depression and hostility and showed
decreased urinary and salivary stress hormone levels (cortisol). Massage therapy may
be eective in reducing diastolic blood pressure and symptoms associated with
hypertension.

Introduction
Maria Hernandez-Reif PhD, Tiany Field PhD,
Josh Krasnegor BA, Z. Hossain,
Hillary Theakston BA, I. Burman LMT
Research Institute, University of Miami School of
Medicine and Nova Southeastern University, Florida,
USA
Correspondence to: Tiany Field, Touch Research
Institutes, Nova Southeastern University, 3301
College Avenue, Fort Lauderdale, FL 33314, USA.
Tel.: 1 954 262 6919; Fax: 1 954 262 3886
Received: March 1999
Revised: April 1999
Accepted: May 1999

...........................................
Journal of Bodywork and Movement Therapies (2000)
4(1), 31^38
# 2000 Harcourt Publishers Ltd

Hypertension, or high blood

pressure, is a common health risk
that can lead to heart disease,
stroke, disability and death (France
& Ditto 1997). Blood pressure
generally increases with age and is
aected by gender, cigarette
smoking, obesity, diabetes, job
stress, family history and other
environmental and sociocultural
factors (France & Ditto 1997,
Wright et al. 1992). Patients with
hypertension show greater anxiety,
stress and depression (Walter et al.

1995, Piccirilo et al. 1998, Everson et

al. 1998), more anger and hostility,
and more marked cardiovascular
reactions to situational stressors
(Ditto & France 1990, Manuck).
Cortisol (stress hormone) and
catecholamine release (e.g. excess
epinephrine); (1) have been shown to
occur as acute responses to stress;
(2) are typically associated with
anxiety; (3) are positively correlated
with blood pressure; and (4) have
been shown to underlie myocardial
damage and sudden cardiac death
(Morse et al. 1992, McCubbin,
Walton et al. 1995). Hostile and

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Hernandez-Reif et al.
aggressive hypertensives, for
example, show elevated plasma
epinephrine (Netter & Neuhauser
1991). In genetically inbred
hypertensive rats, norepinephrine
and dopamine uptake levels were
enhanced compared to controls
(Chivet et al. 1984, Hendley & Fan
1992). Thus, the reduction of
catecholamines (i.e. norepinephrine,
epinephrine and dopamine) and
cortisol (stress hormone) should be
an important goal in the treatment
of hypertension. Recognizing that
blood pressure is determined by
multiple factors (catecholamine and
cortisol levels, individual,
interpersonal and environmental
causes), complementary approaches
may be needed to evaluate,
prevent and treat hypertension
(Sidorenko).
Non-drug treatments, if eective,
can be less expensive and can
avoid potential side-eects
(Khramelashvili 1986) such as those
associated with anti-hypertension
drugs (Aagaard 1981). Some
eective non-drug preventive
measures and treatments include
exercise and reduction of body
weight and dietary salt. Other
non-drug treatments, such as
psychological methods, including
relaxation therapy and biofeedback
have yielded mixed ndings
(Darison et al. 1991, McGrady et al.
1991, Jacob et al. 1992). For
example, some studies have
suggested that biofeedback and
relaxation therapy were more
eective than drug treatment (e.g.
hydrochlorothiazide) for reducing
stress, anxiety and blood pressure
(Sothers & Anker 1989, Blanchard
1990). Other studies have revealed
that relaxation therapy is only
eective for highly motivated
patients with favorable family and
socioeconomic support (Sothers &
Ankers 1989, Blanchard 1990).
Massage therapy has been shown
to eectively reduce anxiety and
depression and lower stress

hormones including catecholamines

(norepinephrine, epinephrine) for
dierent age groups and conditions
(Field et al. 1992, Ironson et al.
1996, Field et al. 1996). In
cardiovascular studies massage
therapy has only been used as an
adjunct to other forms of therapy.
In one study, it was assessed in
conjunction with psychotherapy,
physical therapy, acupuncture and
drug therapy (Demidenko et al.
1988), making it dicult to
determine whether massage therapy
alone would have reduced blood
pressure and other symptoms.
Moreover, catecholamines and
cortisol were not assayed in that
study.
The present study assessed
massage therapy versus progressive
muscle relaxation eects on adults
with hypertension. Massage therapy
was expected to: (1) reduce anxiety,
depression, and hostility scores;
(2) decrease salivary and urinary
cortisol and catecholamine levels
(norepinephrine and epinephrine);
and (3) lower diastolic blood
pressure. Positive eects were also
expected for the progressive muscle
relaxation group, although to a
lesser degree than for the massage
therapy group.

Method
Participants
Thirty adults (21 women and 9 men)
with at least a 6 month long medical
diagnosis of hypertension
participated in this study (M age
51.6 years, S.D. 8.8 years). Data
for ve additional subjects (two
from the massage therapy group)
were rejected due to non compliance
with the treatment protocol. The
participants were from middle
socioeconomic status (M2.3 on the
Hollingshead index), and the
ethnicity of the sample was
distributed 60% Caucasian, 27%
Hispanic and 13% African
American. The criterion for
inclusion in the study was a medical
diagnosis of high blood pressure for
at least 6 months duration.
Individuals were excluded from
participating if they had other
medical conditions (e.g. diabetes or
psychiatric disorders (e.g. bipolar).
Participants reported that their high
blood pressure was controlled and
that they were highly compliant with
their medication intake: 2 and ttests revealed no dierences between
the groups on age, race, and
medication type (e.g. beta-blocker vs
calcium channel blocker) (Table 1).

Table 1 Demographic information and medication type intake by group

Group
Massage

Control

52

50

10
4
1

8
4
3

Sex
Male
Female

6
9

8
7

Medication type
Beta blocker
Calcium channel blocker
Anticoagulant
ACE inhibitor

5
6
3
1

6
5
2
2

Variable
Age
Race
Caucasian
Hispanics
African Americans

x2

t-test

0.80

0.43

1.22

0.54

0.54

0.715

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0.46

0.87

Massage therapy
Procedures
As participants entered the study,
they were randomly assigned to a
massage therapy (n15) or
progressive muscle relaxation
(n15) group and were asked to
continue their drug and nutritional
regimen. Random assignment was
determined by the experimenter who
drew a number out of a box
corresponding to massage (1) or
relaxation (2). Participants were
informed that the therapies were
expected to promote relaxation and
reduce stress and therefore talking
was discouraged during sessions.
Participants who were assigned to
the progressive muscle relaxation
group were informed that they
would receive complementary
massage therapy at the end of the
study.

(d) Pressing down on the shoulders

with the palms of the hand and
pressing mid shoulder trigger
points.

(c) With the knee bent, rubbing the

muscles on the thigh
(d) Long stroking from the heel up
and over the hips.

Arms

Back

(a) Pulling of the arm down toward

the feet and through its natural
range of motion, up and over
the head and out to the side.
(b) Squeezing motions to the hand
and using the thumbs, stroking
the palm of the hand.
(c) Long stroking from the hand
up and over the shoulder.
(d) Round stroking encircling the
shoulder.
(e) Squeezing the Hoku points (the
eshy part of the webbing that
lies between the thumb and the
forenger).
Torso

Massage therapy
Participants assigned to this group
received 30 min therapy sessions
twice a week for ve consecutive
weeks during the afternoon or early
evening. The massages were
conducted by dierent massage
therapists assigned on a rotating
basis to distribute their abilities
across the subject pool and to
prevent the potential confound of
attachment to a particular therapist.
The massage began with the subject
in the supine position and
progressed in the following
sequence:
Head/neck
(a) Holding the neck with both
hands, gentle pressing and
stretching to lengthen the
spine.
(b) With the at of the hand,
stroking one side and then the
other side of the neck from head
to shoulder.
(c) Using the ngertips, small
circular stroking to the jaw and
cheekbone area.

(a) Holding the ribs on both sides,

gently rocking the ribcage side
to side.
(b) Placing one hand on the
abdomen and the other hand on
the forehead and rocking.
Legs
(a) Holding the ankles, keeping the
legs together, pulling straight
downward, and then towards
the left and then the right side.
(b) Squeezing the foot, pressing into
the soles of the foot and using
friction movements with the
thumbs on the top of the foot
following the spaces between the
bones.
(c) Long stroking from the foot to
the hip.
With the participant in a prone position
(a) Lifting leg, bending the foot at
the ankle and stretch the back of
the calf.
(b) Stroking and squeezing up the
calf from the ankle to the knee.

(a) With the heel of the hands on

the sides of the spine, pressing
into the lower back and
stretching the skin towards the
sides of the body.
(b) Firm stroking from the hip to
up and over the shoulders and
over the arms
(c) Grasping and squeezing the tops
of the shoulders.
(d) With the edges of both hands on
either side of the spine, giving
friction to the back from the
neck to the hip.
(e) Squeezing the back of the neck.
(f ) Pressing on the hips with the
heel of the hands.
(g) From the shoulders down the
entire back, long gliding strokes
to the feet.
(h) With one hand on the lower
back and the other on the upper
back, slow rocking motions.

Progressive muscle
relaxation
Participants assigned to this group
performed 30 min sessions
consisting of progressive muscle
relaxation exercises twice a week for
ve consecutive weeks. Participants
were instructed by dierent
therapists and researchers on how to
perform the sessions and to only
perform the sessions on their
assigned days (e.g. every Tuesday
and Friday afternoon or early
evening) to ensure that frequency
and session lengths were comparable
to the time schedule of the massage
therapy group.
The relaxation session began with
the subject in the supine position.
The participant was instructed to
breathe deeply for several minutes

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Hernandez-Reif et al.
and relax placing the hands
alongside the body. Then the
participant was asked to follow the
verbal instructions consisting of
tightening and relaxing dierent
muscles of the body in a feet to head
progression similar to that
progression used in massage
therapy. The muscle groups that
were exercised were the (1) feet,
(2) calves, (3) thighs, (4) hands,
(5) arms, (6) back and (7) face.

Assessments
Pre/post treatment
assessments (immediate
eects)
These assessments were made before
and after the sessions on the rst
and last days of the 5 week study
during our oce hours.
State anxiety inventory (STAI)
This is a 20 item inventory on how
the subject feels at the moment.
Characteristic items include `I feel
nervous', `I feel anxious', `I am
worried'. The STAI scores increase
in response to stress. Research has
demonstrated that the STAI has
adequate concurrent validity and
adequate internal consistency,
r0.83, (Spielberger 1970, 1972).
Salivary samples
These were collected and assayed for
cortisol levels as a measure of stress.
The samples were obtained at the
beginning of the massage therapy or
progressive muscle relaxation
session and 20 min after the end of
the session on the rst and last days
of the study. Due to the 20 min
lagtime in cortisol changes, saliva
samples always reect responses to
stimulation occurring 20 min prior
to sampling (O'Connors & Corrigan
1987). Subjects were asked to place
a cotton dental swab dipped in
sugar-free lemonade crystals along

their gumline for 30 s. The swab was

then placed in a syringe and the
plunger was depressed to express the
saliva into a microcentrifuge tube.
Lower cortisol levels were expected
following the massage sessions
based on previous massage therapy
studies (Sother & Anchor 1989,
Ironson et al. 1996).
Physiological measures
Systolic blood pressure (SBP) and
diastolic blood pressure (DBP) were
recorded using a digital blood
pressure monitor (Lumiscope
Digitronic). To reduce bias, a
second observer veried the
recordings for approximately onethird of the sample. The digital
readings were recorded in the clinic
room where the massage therapy or
progressive muscle relaxation
session occurred. To control for
variations in blood pressure, three
readings were taken with the
participant in a seated position
5 min before and then again three
readings 5 min after the therapy.
Three readings were also taken with
the participant in a reclining
position one minute before and
three other readings one min after
therapy to control for uctuating
blood pressure readings. The data
were reduced by averaging across
the three readings for each
assessment (sitting or reclining)
period pre and post treatment.
First day/last day assessments
(longer-term eects)
The following measures were
collected before the rst and last
day's massage therapy or relaxation
session.
The Center for Epidemiological
Studies Depression Scale
(CES-D)
This is a 20 item scale that rates
depressive symptoms (e.g. `I felt

lonely over the past week') on a

four-point scale (`rarely or none of
the time (0)', `some of the time (1)',
`occasionally (2)', and `most or all
the time (3)'). The items included in
the scale represent the major
symptoms of depression as identied
by clinical judgment, frequency of
use in other questionnaires for
depression and factor analytic
studies. Each item has a possible
value of 03; thus the total score has
a range of 060. The CES-D has
very high internal consistency
(alpha 0.86) and testretest
reliability. In addition, reliability
and validity for this scale have been
acceptable across a variety of
demographic characteristics
including age, education and ethnic
groups (Radlo 1977, Radlo 1991,
Radlo 1978).
The Symptom Checklist-90
Revised (SCL-90 -R)
This is a self-report symptom
inventory. Only those subscales used
for assessing psychological
symptoms for depression, anxiety
and hostility were administered.
Subjects responded to how
distressed they felt over the past
week on items reecting depression
(e.g. `crying easily'), anxiety (e.g.
`heart pounding or racing') and
hostility (e.g. `shouting or throwing
things'). The questions are rated on
a 5-point scale of distress ranging
from 0 (`not-at-all distressed') to 4
(`extremely distressed'). This
inventory has high reliability
measures for internal consistency
(M coecient 0.84), testretest
(M coecient 0.84) and
acceptable construct validity
(Derogatis).
The urinary catecholamines
and cortisol
These were assayed from samples
provided on the rst and last days of
the 5 week study. The samples were

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Massage therapy
frozen and later assayed by highpressure liquid chromatography
with the elcetrochemical detection
(HPLC-ECD) technique for cortisol
and catecholamines
(norepinephrine, epinephrine and
dopamine). Briey, catecholamines
are extracted from a 5 ml aliquot of
urine using a Biorex 70 column. The
extract is injected onto a reverse
phase C18, 5 u column.
Catecholamines are identied by
their characteristic elution patterns
and quantied by using the arearatio method with an internal
standard, on a preprogrammed
computerized data module.
Decreased cortisol and
catecholamine levels were expected
for the massage therapy group by
the end of the 5 week sessions based
on earlier massage therapy studies
(Field 1992, 1996)

Results
Repeated measures multivariate
analyses of variance (MANOVAs),

analyses of variance (ANOVAs) and

Bonferroni t-tests were conducted
with pre and post therapy sessions
and rst and last days of the study
as the repeated measures.
Immediate eects pre-post
treatment measures
The MANOVA on the short-term
measures (STAI, Salivary cortisol
and blood pressure) produced a
group by days by session interaction
eect, F(3,14) 4.32, P50.05.
State Trait Anxiety Inventory
(STAI)
The ANOVA on the STAI revealed
a signicant eect of days, F (1,28)
4.55, P50.05, and sessions,
F( 1,28) 56.82, P50.001,
suggesting that anxiety levels were
lower for both the massage therapy
and relaxation group after the
rst and the last day's session (see
Table 2).

Saliva
A group by days by session
interaction eect, F (1,23) 5.51,
P50.05, revealed a reduction in
cortisol only for the massage
therapy group after the rst and last
massage session on the rst and last
days of the study (Table 2).
Blood pressure
No signicant interaction eects
were obtained for systolic blood
pressure. The ANOVA on diastolic
blood pressure, however, revealed a
group by session interaction eect
for sitting, F (1,20) 5.63, P50.05
and a group by session by day
interaction eect for reclining blood
pressure, F (1,20) 3.61, P50.05.
Subsequent t-tests showed for the
massage therapy group a decline
(1) in sitting diastolic blood pressure
after the rst and last day's massage
and (2) in reclining blood pressure
from the rst to the last day pretreatment (Table 2).

Table 2 Means (and standard deviations in parantheses) for massage group and relaxation groups for pre/post session and rst last days measures
Massage group

Relaxation group

First day
Variables
Short term measures
STAI (anxiety)
Saliva cortisol
Blood pressure
Systolic
reclining
sitting
Diastolic
reclining
sitting
Long-term measures
Depression (CES-D)
SCL-90R
Depression
Anxiety
Hostility

Last day

First day

Last day

Pre

Post

Pre

Post

Pre

Post

Pre

Post

36.2 (11.0)a
1.6 (0.6)a

26.4 (7.5)b4
1.2 (0.5)b1

32.3 (11.6)a
1.9 (1.1)a

25.3 (8.9)b4
1.2 (0.6)b2

39.7 (8.5)a
1.2 (0.6)b

28.7 (9.3)b
1.2 (0.5)b

34.7 (5.9)a
1.1 (.3)b

26.6 (3.1)b4
1.4 (.5)b

135 (15)a
140 (19)a

134 (17)a
136 (21)a

133 (16)a
142 (19)a

132 (14)a
133 (19)b1

133 (12)a
136 (15)a

132 (13)a
34 (11)a

133 (14)a
136 (18)a

132 (18)a
138 (20)a

83 (9)a
89 (8)a
First day
17.8 (11.5)a

81 (9)a
82 (9)b2

78 (9)b1
85 (6)a
Last day
8.3 (7.0)b2

81 (7)a
81 (7)b1

82 (8)a
88 (7)a
First day
17.1 (13.5)a

85 (9)a
88 (6)a

84 (11)a
86 (14)a
Last day
12.8 (5.8)c1

85 (11)a
88 (12)a

16.4 (10.2)a
5.2 (4.5)a
3.5 (2.9)a

5.0 (6.8)b2
1.3 (1.1)b2
1.2 (0.8)b1

15.1 (12.0)a
5.4 (5.2)a
3.8 (4.7)a

11.0 (5.4)a
4.0 (1.4)a
3.2 (1.1)a

Dierent letter subscript denotes statistically dierent means within groups for pre/post measures (short-term) or rst/last day measures (longterm). A superscript denoted on a pre measure indicates signicantly dierent means for rst day pre versus last day pre value. 1P 0.05, 2P 0.01,
3
P 0.005, 4P 0.001.
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Hernandez-Reif et al.
Long-term eects rst^last day
measures
The MANOVA on the longer-term
measures (CES-D, SCL-90-R)
revealed a group by days interaction
eect, E (4,20) 4.52, P50.05.
CES-D
The ANOVA on the depression
score yielded a signicant eect of
days, F (1,28) 8.13, P50.01,
suggesting that depression scores
were lower for both the massage
therapy and relaxation group by
the end of the study. However, an
analysis of the change score
(i.e. Last day's CES-D score minus
baseline CES-D) revealed that
depression scores were signicantly
lower for participants receiving
massage therapy than for those
conducting relaxation sessions
t(22) 2.82, P50.01 (Table 2).
SCL-90-R
A signicant group by days
interaction eect, F (3,21) 3.90,
P50.05, and subsequent t-tests
revealed a reduction in depression,
t (14) 4.26, P50.01, anxiety,
t (14) 3.26, P 5 0.01, and
hostility, t (14) 2.31, P50.05, only
for the massage therapy group
(Table 2).
Urinary catecholamines and cortisol
Scatterplots revealed that the data
were not normally distributed. Thus,
non-parametric methods were
applied. Wilcoxon Matched Pairs
Signed Ranks Tests revealed a
decrease in urinary cortisol (Z 2.3,
P50.05) for the massage therapy
group (Table 3).

Discussion
For the massage therapy group,
sitting diastolic and systolic blood
pressure decreased after the rst and
last sessions and reclining diastolic
blood pressure declined from the
rst to the last day of the 5 week

Table 3 Means for massage and relaxation groups.Wilcoxon Sign RankTest and p-values for
urinary cortisol and catecholamine
Massage

Relaxation

Measure

First/Last

z=

p5

First/Last

z=

p5

Cortisol
Norepinephrine
Epinephrine
Dopamine

125/109
37/47
7/7
294/284

3.56
1.96
0.39
1.00

0.05
NS
NS
NS

108/102
34/58
8/7
317/322

1.35
0.67
1.21
0.40

NS
NS
NS
NS

study. Both the massage therapy

and relaxation therapy groups
reported less anxiety and depression
on two psychometric measures
(STAI and CES-D). However, stress
hormones (both salivary and urinary
cortisol) decreased only for the
massage therapy group. Moreover,
an additional psychometric measure
(SCL-90-R) revealed lower
depression, anxiety and hostility
scores only for the massage therapy
group. The improved psychological
state might have contributed to the
observed decrease in diastolic blood
pressure for the massage therapy
group or vice-versa, perhaps via
the reduced cortisol production.
A decrease in stress hormone
production might be the mechanism
underlying the observed reduction in
diastolic blood pressure in that acute
response to stress has been
correlated with myocardial damage
and even cardiac death (McCubbin,
Morse 1992). The positive ndings
for the massage therapy group
might also be the result of increased
parasympathetic activity. Vagal tone
(an index of parasympathetic
activity) has been noted to increase
following massage therapy (Scadi
1996).
That the progressive muscle
relaxation group did not show
reduced stress hormones or
improved scores on the additional
psychometric measure (SCL-90-R)
contradicts their report of reduced
anxiety (STAI) and depression
(CES-D) following progressive
muscle relaxation. Perhaps the SCL-

90-R assessment is more sensitive in

tapping more hostile depression or
anxiety. Moreover, that cortisol
stress levels and diastolic blood
pressure did not decrease suggests
that progressive muscle relaxation
may not be eective for reducing
hypertension or associated
symptoms. The results are consistent
with another study showing that
relaxation therapy was not superior
to the control condition for
medicated hypertension patients
(Davison 1991), perhaps because
relaxation therapy requires
compliance and exertion. In
contrast, because massage therapy
requires no exertion and little if any
participation, it might be more
eective in ameliorating symptoms
associated with hypertension.
An alternative hypothesis might
be that the improved scores for the
massage therapy group were the
result of the additional attention
they received from the therapist.
Except for the rst and last day's
session, which was conducted by a
therapist, the relaxation group
conducted their sessions at home.
Future research might examine if
relaxation sessions directed by
therapists, as opposed to
participants, eectively reduce
symptoms associated with high
blood pressure.
Why urinary catecholamine levels
did not decrease is unclear.
Although immediate reduction in
stress hormones was evident with
massage therapy, decreases in
catecholamine production for

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Massage therapy
individuals with hypertension
symptoms might require longer or
more frequent treatments. Or
perhaps the participants were not
highly stressed as initial levels were
only slightly above normal. Future
research might examine massage
therapy eects for individuals with
hypertension who are highly
stressed. Perhaps daily or weekly
blood pressure readings, longer-term
monitoring of stress hormone
production and stress symptoms
might help our understanding of the
potential eects of massage therapy
as a complementary treatment for
hypertension. Longer-term followup might also help determine
whether the results reected shortterm eects or whether the results
would have persisted beyond the
treatment sessions. If massage
therapy can eectively reduce
symptoms associated with
hypertension, then it might
reduce life-threatening
complications, such as the risk of
stroke or heart attack.
ACKNOWLEDGEMENTS
The authors thank the men and women
who participated in this study and the
therapists who provided the massage
therapy. This research was supported by
an NIMH Research Scientist Award
(#MH00331) and Johnson and
Johnson support funds to Tiany
Field.

REFERENCES
Aagaard G 1987 A nondrug approach to the
treatment of hypertension. In: Drayer J,
Lowenthal D, Weber M (Eds) Drug
Therapy in Hypertension, New York,
Marcel Dekker, 2744
Blanchard E 1990 Biofeedback treatments of
essential hypertension. Biofeedback &
Self-Regulation 15: 209228
Chiu P, Rajakumar G, Chiu S, Kwan CY,
Mishra RK 1984 Dierential changes in
central serotonin and dopamine receptors
in spontaneous hypertensive rats.
Progress in Neuro-Psychopharm & Biol
Psych 8: 665668

Davison GC, Williams ME, Nezami E, Bice

TL, DeQuattro VL 1991 Relaxation,
reduction in angry articulated thoughts,
and improvements in borderline
hypertension and heart rate. J of Behav
Med 14: 453468
Demidenko T, Balunov O, Bogat Z, Dokish
Y, Kantimulina N, Pelisova L 1988
A system of rehabilitation for
cardiovascular patients. Soviet Neur and
Psychiatry 21: 8291
Derogatis LR 1983 SCL-90-R. Clinical
Psychometric Research
Ditto B, France C 1990 Carotid baroreex
sensitivity at rest and during
psychological stress in ospring of
hypertensives and nontwin sibling pairs.
Psychosom Med 52: 610620
Everson SA, Roberts RE, Goldberg DE,
Kaplan GA 1998 Depressive symptoms
and increased risk of stroke mortality
over a 29-year period. Archives of
Internal Medicine 158: 11331338
Field T, Morrow C, Valdeon C, Larson S,
Kuhn C, Schanberg S 1992 Massage
therapy reduces anxiety in children and
adolescent psychiatric patients. J Am
Acad Child & Adoles Psychiatry 31:
125131.
Field T, Grizzle N, Scadi F, Schanberg S
1996 Massage and relaxation therapies'
eects on depressed adolescent mothers.
Adolesc 31: 903911
France CR, Ditto B 1997 Risk for high blood
pressure and decreased pain perception.
Current Directions in Psychological Sc 5:
120125
Hendley ED, Fan X 1992 Regional
dierences in brain norepinephrine and
dopamine uptake kinetics in inbred rat
strains with hypertension and/or
hyperactivity. Brain Res 586: 4452
Ironson G, Field T, Scadi F et al. 1996
Massage therapy is associated with
enhancement of the immune system's
cytoxic capacity. Intl J of Neurosc 84:
205217
Jacob RG, Shapiro AP, O'Hara P et al.
Relaxation therapy for hypertension:
setting specic eects. Psychosom Med
54: 87101.
Khramelashvili V, Aivazyan T, Salenko 1986
Psychological nonpharmacological
treatment of hypertension and criteria
for its ecacy. Hypertension:
Psychophysiological, Biobehavioral and
Epidemiological Aspects. Wash, DC: US
Department of Health and Human
Services (NIH Pub No. 86-2704)
Lumiscope Digitronic 1081 1990 Digital
Blood Pressure and Pulse Monitor, The
Lumiscope Company, Inc., Edison, NJ
Manuck S, Morrison R, Bellack A
1986 Psychological factors in

hypertension. Hypertension:
Psychophysiological, Biobehavioral
and Epidemiological Aspects. Wash,
DC: US Depart of Health and Human
Services (NIH Pub No. #86-2704),
119138
McCubbin JA 1989 Diminished opiod
inhibition of blood pressure and pituitary
function in hypertension development.
In: McCubbin JA, Kaufmann PG,
Nemero CB (Eds) Stress, neuropeptides,
and systemic disease. New York: Plenum
Press, 113122
McGrady A, Nadsady PA, SchumannBrzezinski C 1991 Sustained eects of
biofeedback-assisted relaxation therapy
in essential hypertension. Biofeedback &
Self-Regulation 16: 399411
Morse DR, Martin J, Moshonov J 1992 Stress
induced sudden cardiac death: can it be
prevented? Stress Med 8: 3546
Netter P, Neuhauser MS 1991 Types of
aggressiveness and catecholamine
response in essential hypertensives and
healthy controls. J Psychosom Res
35: 409419
O'Connor P, Corrigan D 1987 Inuence of
short-term cycling on salivary cortisol
levels. Med Sci Sports Exerc 19:
224228
Piccirillo G, Elvira S, Viola E et al. 1998
Autonomic modulation of heart rate and
blood pressure in hypertensive subjects
with symptoms of anxiety. Clinical Sc
95: 4352
Radlo L 1977 The CES-D scale: A selfreport depression scale for research in the
general population. Applied Psychol
Measure 1: 385401
Radlo L 1991 The use of the Center for
Epidemiological Studies Depression
Scale in adolescents and young adults.
J Youth Adolsec 20: 149165
Radlo L, Locke BZ 1978 The Community
Mental Health Assessment Survey and
the CES-D Scale. In: Weissman M,
Myers J, Ross C (Eds), Community
Surveys. New Brunswick, NJ, Rutgers
University Press
Scadi F, Field T, Wheeden A et al. 1996
Cocaine-exposed preterm neonates show
behavioral and hormonal dierences. Ped
97: 851855.
Sidorenko G, Pavlova A, Ageyenkova E,
Antonovich M, Nechesova T 1986
Hypertension: Psychophysiological,
Biobehavioral and Epidemiological
Aspects. Wash, DC: US Depart of
Health and Human Services (NIH
Pub.No. 86-2704), 139150
Sothers K, Anchor KN 1989 Prevention and
treatment of essential hypertension with
meditation-relaxation methods. MedPsychotherapy Intl J 2: 137156

37

J O U R NAL O F B O DY WO R K A N D MOV E M E N T TH E R API E S JANUARY 2 0 0 0

Hernandez-Reif et al.

Spielberger CD, Gorsuch RL, Lushene RE

1970 The State Trait Anxiety Inventory,
Palo Alto, CA: Consulting Psychologists
Press
Spielberger CD 1972 Anxiety as an emotional
state. Anxiety: Current Trends in Theory

and Research, New York: Academic

Press
Walton KG, Pugh ND, Gelderloos P, Macrae
P 1995 Stress reduction and preventing
hypertension: preliminary support for a
psychoneuroendocrine mechanism.

J Alternative Complementary Med 1:

263283
Wright L, Carbonari J, Voyles W 1992
A factor analytic study of physical risk
variables for CHD. J of Clin Psychology
48: 165170

38

J O U R NAL O F B O DY WO R K A N D MOV E M E N T TH E R API E S JANUARY 2 0 0 0