Acupressure reduced pain, anxiety and heart rate in victims of minor trauma before they reached the hospital, according to recent research.

The study, “Prehospital [sic] Analgesia with Acupressure in Victims of Minor Trauma: A Prospective, Randomized, Double-Blinded Trial,” was conducted by researchers at the University of Vienna Department of Anesthesia and Intensive Care, the Vienna Red Cross, and the Research Institute of the Vienna Red Cross.

Sixty people, ages 19 to 99, participated in the study once initial medical intervention, such as bandaging, was complete. They all suffered from similar small injuries, such as simple fractures, small wounds and contusions.

At the site of the accident, a paramedic measured victims’ blood pressure and heart rate, and asked them to rate their pain and anxiety on a scale of zero to 100. Subjects were also asked to rate their belief in acupressure as a treatment for pain. They were then assigned to one of three groups: true acupressure, sham acupressure or no acupressure.

Another paramedic performed the acupressure for approximately three minutes, then brought the subject to the ambulance. This paramedic was not aware that one of the acupressure treatments was false, but was instead told that the aim of the study was to compare two acupressure techniques using different points. Data collection was always performed by the other paramedic, in the absence of the one applying acupressure.

Upon arrival at the hospital, subjects were again asked to rate their pain and anxiety; blood pressure and heart rate were measured. Subjects were also asked to rate their overall satisfaction on a scale of zero to 100.
“After treatment the three groups differed in a highly significant way in pain, anxiety, and heart rate,” state the study’s authors.

In the true acupressure group, 89 percent of the subjects had a significant heart-rate reduction. This group also experienced a significant decrease in pain and anxiety, and had significantly better patient-satisfaction scores.

In the other two groups, measurements of pain and heart rate remained unchanged. Although there was a decrease in anxiety for both groups, it was not statistically significant. Belief in acupressure did not differ among the three groups.

“In summary,” state the study’s authors, “our results could show that acupressure is an effective and easy-to-learn treatment for pain in first aid and emergency trauma care. We recommend this technique for emergency physicians and also for nonacademic personnel, such as nurses, paramedics, firefighters, or emergency medical technicians.”

-Source: University of Vienna Department of Anesthesia and Intensive Care, Vienna Red Cross, and the Research Institute of the Vienna Red Cross. Authors: Alexander Kober, M.D., Thomas Scheck, M.D., Manfred Greher, M.D., Frank Lieba, Roman Fleischhackl, Sabine Fleischhackl, Frederick Randunsky, and Klaus Hoerauf, M.D. Originally published in Anesthesia & Analgesia, 2002, Issue 95, pp. 723-727.

Massage eased the feeling of lumbar fatigue in subjects who performed sustained back extensions, according to a recent study.

“The effect of massage on localized lumbar muscle fatigue” was conducted by Tim Hideaki Tanaka, Gerry Leisman, Hidetoshi Mori and Kazushi Nishijo. The study was supported by a research grant from the College of Massage Therapists of Ontario and was a collaboration of the Pacific Wellness Institute in Toronto, Ontario, Canada; the Rennselaer Polytechnic Institute Department of Cognitive Neuroscience in Troy, New York; and Tsukuba College of Technology in Ibaragi, Japan.

Twenty-nine subjects without back pain, ages 18-30, participated in the study. The study tested the hypothesis that massage on the low back affects the degree of low-back muscle fatigue caused by muscle contraction.

“Localized muscle fatigue can be induced by sustained muscular contractions and is associated with such external manifestations as inability to maintain a desired force output, muscular tremor and localized pain,” state the study’s authors.

Each subject participated in two sessions, one rest and one massage, on two separate days. Each participant was asked to lie prone on the table with his hands crossed behind his head and slowly extend his trunk until the inferior portion of his rib cage no longer rested on the table. This position was held for 90 seconds.
Depending on which treatment session the participant was involved in that day, he or she then received either massage on the lumbar region for five minutes or rested for five minutes. Subjects were then asked to repeat the 90-second extension.

Immediately after each muscle contraction, participants were asked to rate their level of fatigue on the visual analogue scale for fatigue. Electrodes were attached to the subjects throughout the session to get electromyographic (EMG) readings, which were used to measure muscle fatigue.

According to the EMG readings, massage had no significant effect on muscle fatigue. However, a paired t-test indicated that there was a significant increase in fatigue on the visual analogue scale for those participants who simply rested between back extensions.

“Massage application on the lumbar region provides significant difference in the fatigue scale as compared to rest, suggesting that massage application helped the subjects overcome the subjective feeling of fatigue,” state the study’s authors.

- Source: The Pacific Wellness Institute in Toronto, Ontario, Canada. Authors: Tim Hideaki Tanaka, Gerry Leisman, Hidetoshi Mori and Kazushi Nishijo. Originally published in Complementary and Alternative Medicine, 2002, Vol. 2, No. 9. This study is available at www.biomedcentral.com/1472-6882/2/9

Massage therapy reduced neurological complications and increased patients’ perception of the benefits of therapy following a bone marrow transplant. Both massage therapy and Therapeutic Touch® significantly increased patients’ comfort after the bone marrow transplant, according to a recent study.

“Outcomes of Touch Therapies During Bone Marrow Transplant” was conducted by Marlaine Smith, R.N., Ph.D., and Francelyn Reeder, R.N., Ph.D., of the University of Colorado Health Sciences Center School of Nursing; Linda Daniel, R.N., Ph.D.; Julaluk Baramee, R.N., Ph.D.; and Jan Hagman, R.N., clinic coordinator of the Outpatient Bone Marrow Transplant Unit of the University of Colorado Hospital in Denver.

Participants were patients 18-70 years old who received either an autologous or allogeneic bone marrow transplant (BMT), mostly for breast cancer or lymphoma, but also for leukemias. An autologous BMT involves the collection of the patient’s own bone marrow, which is frozen and reinfused; an allogeneic BMT is the transplantation of another person’s marrow.

The sample population of 61 patients was stratified and randomly assigned to one of three treatments: massage therapy, Therapeutic Touch, or a control group called the friendly visit.

Subjects in the massage-therapy group received a 30-minute, standardized Swedish massage. Those in the Therapeutic Touch group received a half-hour, standard session, which consisted of conscious energy exchange using the hands as a focus for facilitating healing. Subjects in the friendly visit group spent 30 minutes engaged in social conversation.
Three outcome variables were measured to assess the effects of touch therapies on people who undergo BMTs: time for engraftment, which occurs when newly infused blood-forming cells begin producing blood; complications during treatment, which involved the measurement of 11 specific functions such as food intake, central nervous system/neurological, cardiac and circulation; and patients’ perception of the benefit of therapy, which involved a survey asking subjects to rate the degree of feelings such as support, comfort, well-being, pain and anxiety.

In the assessment of complications, researchers found that subjects in the massage-therapy group had significantly lower scores for central nervous system or neurological complications, such as disorientation, agitation, anxiety, numbness, headache and insomnia.

“This diminishing effect on neurological complications is important in enhancing the quality of life during BMT,” state the study’s authors. “Massage-therapy patients may be able to rest more easily, communicate with their family members, and feel less depressed and anxious during this critical time.”

No statistical differences were found among the three groups for time for engraftment. Participants in the massage-therapy group perceived that they received significantly greater benefits from the therapy than those in the friendly visit group. Subjects in both the massage-therapy and the Therapeutic Touch group had comfort scores significantly higher than subjects in the friendly visit group.

- Source: University of Colorado Health Sciences Center School of Nursing and Hospital in Denver. Authors: Marlaine Smith, R.N., Ph.D.; Francelyn Reeder, R.N., Ph.D.; Linda Daniel, R.N., Ph.D.; Julaluk Baramee, R.N., Ph.D.; and Jan Hagman, R.N. Originally published in Alternative Therapies in Health and Medicine, January/February 2003, Vol. 9, No. 1, pp. 40-49

Aggressive adolescents who received massage therapy had lower anxiety, reported feeling less hostile, and were perceived by their parents as less aggressive, according to a recent study.

“Aggressive Adolescents Benefit From Massage Therapy” was conducted by Miguel Diego, Tiffany Field, Ph.D., Maria Hernandez-Reif, Ph.D., Jon Shaw, Eugenio Rothe, Daniel Castellanos and Linda Mesner.

Seventeen adolescents, ages 9 to 14, were recruited from a child and adolescent psychiatry outpatient clinic for the study. Aggression type (affective aggressive, predatory aggressive or mixed) was determined using the 10-item Aggression Questionnaire. Affective aggression is reactive, and is characterized by high levels of arousal and poor behavior control. Predatory aggression is goal-oriented, and is characterized by low arousal and planned arousal.

Subjects were stratified by age and aggression type and randomly assigned to either a massage-therapy group or a progressive muscle-relaxation group.
Participants in the massage-therapy group received two 20-minute chair massages per week for five weeks. The massage therapist, different each session, gave a standard massage with the adolescent fully clothed.

Participants in the relaxation-therapy group were instructed to tense and relax each of the major muscle groups in the back, arms, face and neck during 20-minute sessions that occurred twice a week for five weeks.
Assessments were made using the Overt Aggression Scale, completed by the parents to evaluate overall aggressive behavior; the Child Behavior Checklist, completed by the parents to measure behaviors associated with aggression and hostility; the hostility portion of the SCL-90R, a questionnaire completed by the subjects to assess distress experienced in the past week; and the State Anxiety Inventory for Children, designed to measure levels of anxiety.

Only the massage-therapy group showed a significant decrease in aggression on the Overt Aggression Scale, as well as a significant decrease in aggression scores on the Child Behavior Checklist. Again, it was the massage-therapy group alone that showed a significant decrease in hostility on the SCL-90R and a significant decrease in anxiety on the State Anxiety Inventory for Children.

“Anxiety has been associated with aggressive behavior and may influence the expression and modulation of aggressive behavior through its effects on social interactions,” state the study’s authors. “Participants receiving massage therapy reported feeling significantly less anxious after a 20-minute session on both the first and last days of treatment, but participants receiving progressive muscle relaxation did not.”

The authors recommend a larger study to explore the effects of massage on the specific types of aggression.

- Source: Touch Research Institute. Authors: Miguel Diego, Tiffany Field, Ph.D., Maria Hernandez-Reif, Ph.D., Jon Shaw, Eugenio Rothe, Daniel Castellanos and Linda Mesner. Originally published in ADOLESCENCE, Vol. 37, No. 147, fall 2002, pp. 598-607.

Infants who were massaged before bedtime adjusted to a more favorable rest-activity cycle by the age of 8 weeks and produced more melatonin, a sleep regulator, during the night by the age of 12 weeks, according to a recent study.

“Massage Therapy by Mothers Enhances Adjustment of Circadian Rhythms to the Nocturnal Period in Full-Term Infants” was conducted by Sari Goldstein Ferber, Ph.D., Moshe Laudon, Ph.D., Jacob Kuint, M.D., Aron Weller, Ph.D., and Nava Zisapel, Ph.D.

Twenty-one mother-infant pairs were randomly assigned to one of two groups: the treatment group, in which mothers massaged their infants before bedtime, or the control group, in which there was no intervention.

Mothers in the treatment group were instructed to get their babies ready for bed between 8-9 PM, and to provide 30 minutes of massage therapy to the infant every day for 14 days, starting when the infants were 10 days old.

The massage consisted of light, circular strokes of the baby’s back with one hand, while touching the baby’s head with the other hand. After 14 days, the massage was discontinued.

Both groups restricted light in the baby’s room to the hours of 6 AM - 8 PM.

Actigraph measures, which monitor the number of movements per minute, were taken at 6 and 8 weeks of age. Mothers placed an actigraph Velcro belt on one of their infant’s legs for a 20-hour recording period.
Activity levels of the groups were compared during five four-hour time spans: 11 PM - 3 AM, 3 - 7 AM, 7 - 11 AM, 11 AM - 3 PM, and 3 - 7 PM. Diaries accounted for movement during diaper changes or other events, and actigraph readings for these time periods were discarded.

At 8 weeks, infants in the massage group experienced peak activity from 3 - 7 AM, while peak activity of infants in the control group happened from 11 PM - 3 AM.

A secondary peak of activity for infants in the massage group was 3 - 7 PM. For infants in the control group, it was 11 AM - 3 PM.

“The activity hours of the treated infants may ” be more supportive of maternal well-being compared with the activity hours of the nontreated controls, as they seem better adjusted to the mother’s schedule,” state the study’s authors.

Urinary excretion of 6-sulphatoxymelatonin at night was evaluated. Excretion of this substance reflects the production of the hormone melatonin, a sleep regulator and time cue in humans. Diapers used by the infants during the night (7 PM - 8 AM) were collected and analyzed at ages 6, 8 and 12 weeks.

At 12 weeks, the nocturnal urinary excretion of 6-sulphatoxymelatonin was significantly greater in the treated infants compared to the control group.

“Practitioners may be advised to instruct mothers to provide behavioral presleep massage treatment in early infant care, because the results strongly indicate that this may have long-term, beneficial effects on development of properly phase-adjusted rhythmicity,” state the study’s authors.

- Source: Tel Aviv University departments of neonatology and neurobiochemistry in Tel Aviv, Israel; Neurim Pharmaceuticals Ltd.; and the Bar Iian University Department of Psychology. Authors: Sari Goldstein Ferber, Ph.D., Moshe Laudon, Ph.D., Jacob Kuint, M.D., Aron Weller, Ph.D., and Nava Zisapel, Ph.D. Originally published in the Journal of Developmental and Behavioral Pediatrics, December 2002, Vol. 23, No. 6, pp. 410-415.

Massage therapy is a wonderful and beneficial form of holistic health care. Massage can provide stress relief, muscle tension relief, improve circulation, and the list goes on. But massage can be detrimental to your health if you have certain physical conditions, illnesses, or disease. You can also put your therapist at risk of contracting certain illness or disease if you are in a contagious state of health.

The term “massage contraindication” means you are not able to receive massage, or the massage may be limited to certain areas of your body. When you are contraindicated for a massage it is for your health and safety as well as the massage therapists. Not all contraindications mean that you will never be able to have a massage. There are two types of contraindications: local contraindications and absolute contraindications.

Local Contraindications

Local contraindications are conditions involving a pathology related illness/disease or an acute injury. These conditions mean caution must be exercised and the massage must be adapted to the condition. This is to ensure the safety of both the client and the therapist. For the client, the massage must be adjusted as to ensure it will not spread the condition, or further injure the client. For the therapist, it is to ensure the therapist does not contract the disease.

If you have what is determined to be a local contraindication your therapist may require a doctor’s release before he will agree to provide you with a massage. While some local contraindications only require that you and your therapist discuss the condition and tailor the massage accordingly. In either case, it is the therapist that will make the final decision as to whether or not you will be able to receive the massage. This is done to protect your health and safety as well as the massage therapist.

A massage may be adjusted for a local contraindication in several ways. It can mean an area is to be avoided, such a the lower leg of a recently sprained ankle. It can require that the pressure be adjusted during the massage. The position in which the client is lying the massage table is adjusted, such as using a side lying position for pregnant women. It can also mean the time allowed for the massage be adjusted.

Some of the more common local contraindications include, but are not limited to: Abnormal lumps, Ance Vulgaris, athlete’s foot, blisters, bruises, Carpal Tunnel Syndrome, Colitis, Crohn’s Disease, Cystitis (Baker’s and sebaceous), Decubitus Ulcers, Gouty Arthritis, Graves’ Disease, hernia, Hyper and Hypothyroidism, infectious diseases, Irritable Bowel Syndrome, local inflammation, open wounds, Phlebitis, poison ivy - oak - sumac, Shingles, swollen lymph glands, ulcers, unhealed burns (sunburn if not widespread), Varicose Veins, and warts.

The following conditions will require a medical doctors clearance: Acromegaly, Aneurysm, Atherosclerosis, Burns, Cancer, Cerebrovascular accident, Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, Coronary Artery Disease, Hemophelia, Hodgkin’s Disease, Kidney Stones, Leukemia, Myasthenia Gravis, Nephrosis, Peritonitis, Polycystic Kidney Disease, and Uremia.

Absolute Contraindications

Absolute contraindications are conditions where you cannot receive a massage. Giving a massage to someone who has an absolute contraindication can result in serious health risks for the client and/or the therapist. Some absolute contraindications can even cause death to the client.

Not all absolute contraindications are permanent; meaning you may have a condition that, once it clears, you can receive a massage. These conditions are typically an illness such as a viral infection. Some conditions are permanent and unfortunately if you have one, you will not be able to receive massage. In either case, as long as the condition is in an acute stage, you will be denied massage therapy.

The following is a list of common, but temporary, absolute contraindications for massage: Chickenpox, Contact Dermatitis (if wide spread), diarrhea (if due to infection), fever, German Measles, Gout (during acute phase), Hepatitis, Hives, High Blood Pressure (unless controlled by medication, diet or exercise) Influenza (the flu), lice, Lupus (during a flare up), measles, Mononucleosis (mono), Mumps, Pneumonia, Ringworm, recent injuries or surgeries, Scabies, and Tonsillitis. This list is not definitive, but a list of the more common conditions that are absolute contraindications. These are all temporary conditions that once they have run their course, you can receive a massage.

The following conditions are a permanent condition that will prevent you from receiving a massage. These are serious conditions and if you receive a massage it can cause further health related problems or even death. Your massage therapist must be informed of these conditions. This is one of the reasons you are required fill out a health history form when you enter a professional massage therapists office.

Some common absolute permanent contraindications (this is not a definitive list): Blood Clots, Cirrhosis of the liver, Deep Vein Thrombosis (DVT), Embolism, Hypertension (unless controlled by medication, diet or exercise), Intestinal obstruction, Kidney failure, Lymphangitis, Myocarditis, Pericarditis, Pulmonary Embolism, Severe Acute Respiratory Syndrome (SARS), Syncope (fainting), and Tuberculosis.

While massage has many benefits certain conditions warrant caution. If you have a condition that has not been listed here, or you are unclear about whether you can receive massage, talk to your massage therapist and you family doctor. They will both be happy to discuss this with you. Remember, if you are turned down for a massage because of a condition you have, it is because the massage therapist has your best health at interest.

Daniel J. Brownell, LMT
Full Throttle Massage, Inc.
Chattanooga, TN
http://www.fullthrottlemassage.com

Massage offers real health benefits, so much so that some conventional hospitals are making them a standard therapy for surgery patients and others.

This interesting CNN article details many of these benefits (including some that may surprise you). Along with promoting relaxation and improving your sense of well-being, getting a massage has been shown to:

Relieve pain (from migraines, labor, fibromyalgia and even cancer)
Boost your level of alertness and attention
Increase your body’s natural killer cells, which help your immune system to defend against illness
Reduce stress, anxiety and depression, and ease insomnia
Decrease symptoms of PMS

Sources:
CNN.com March 8, 2007

To get health benefits, you need a massage that applies moderate pressure. “Your skin needs to be indented as the therapist’s hands move across it,” says Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine. Here are four basic types that fit the bill:

Swedish
If you just ask for a massage, it’s probably what you’re getting. Expect long, gentle, soothing strokes—and general relaxation. Its hallmark is improved circulation. The therapist will use her hands and fingertips and not push too hard (unless you like a lot of pressure).

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Deep Tissue (a.k.a. sports massage)
It’s more intense than Swedish—and it’s not just for athletes. The therapist targets the muscles and ten-dons just under the skin and the deeper ones by using more pressure from her fingertips. Stretches may be included.

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Trigger Point Therapy (a.k.a. myotherapy)
Ask for this type when specific areas of the body are supertense—say, when you have knots in your shoulders. The therapist might press her thumb (or knuckle or elbow) deep into the knot in hopes of releasing it.

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Hot Stone Massage
The therapist rests or moves hot stones along your body, and the heat increases blood flow to the muscles more than other kinds of massage. It may be especially good after your first run-in with a new activity like Pilates.

By Kristyn Kusek Lewis, Illustrations by Kay Dockrill

By Kristyn Kusek Lewis
Health.com

Having your honey rub your back is sweet, but it’s tough to compete with the hands of a pro. A good massage therapist can make you feel like a new person. And now research suggests massage can ease insomnia, boost immunity, prevent PMS, and more. Maybe that’s why hospitals are making it a standard therapy.

“All of our surgery patients are offered the treatment — I call it ’service with a smile’ — and it’s a mandatory weekly prescription I give myself,” says Mehmet C. Oz, M.D., director of the Cardiovascular Institute at New York Presbyterian Hospital–Columbia Presbyterian Medical Center and a member of the board at LLuminari, a health-education company.

Our advice: Enjoy your hands-on time with your sweetie, but set aside some time for a real massage, too. Here are some feel-good reasons:

Goodbye, pain

It sounds like a no-brainer, but rubdowns are especially effective for aches like low-back pain. Researchers at the Group Health Center for Health Studies in Seattle, Washington, found that massage works better than common treatments including chiropractic therapy and acupuncture. It’s not clear why, but several studies show massage reduces levels of the stress hormone cortisol while boosting the feel-good hormones serotonin and dopamine. Those changes slow your heart rate, reduce blood pressure, and block your nervous system’s pain receptors. Massage also increases blood flow to the muscles, which may help them heal. (Health.com: Frequently asked questions about massage )

A bonus: Massage also seems to ease distress from migraine, labor pain, and even cancer, as well as the body tenderness seen with fibromyalgia, says Tiffany Field, Ph.D., director of the Touch Research Institute at the University of Miami School of Medicine. Plus, the benefits may last as long as a year after just a few treatments, says Partap Khalsa, Ph.D., a chiropractor and a program officer at the National Institutes of Health’s National Center for Com­plementary and Alternative Medicine, the agency funding many major studies on massage.

Hello, dreams

Fluctuations in several types of brain waves either relax you or wake you up. Massage increases delta waves — those linked with deep sleep — according to a study at the Touch Research Institute. That’s why it’s easy to drift off on the massage table, Field says.

Nice to have you back, brain power

The Touch Research Institute study that connected massage to sleep also found that a 15-minute chair massage boosted alertness. “Subjects reported that it felt like a runner’s high,” Field says. Tests also show that brain-wave activity stimulated by massage is linked to improved attention.

Take that, colds

Massage helps ward off bugs by boosting your “natural killer cells,” the immune system’s first line of defense against invading illness. “We know that cortisol destroys natural killer cells,” Field says. “Therefore, since massage decreases cortisol, your immune cells get a boost.” Massage even seems to boost immunity in those people with severely compromised immune systems, such as breast-cancer patients. (Health.com: Which massage is best for you?)

Blues, be gone

Less cortisol and more serotonin and dopamine in your system may also mean less stress, anxiety, and depression. “We know that the right side of the frontal lobe of the brain is more active when we’re sad, and the left side’s activated when we’re happy,” Field says. “Our studies have observed that massage decreases activity in the right lobe and increases functioning in the left.” The well-being people feel after a massage is a big reason why some hospitals offer it to anxious patients pre­paring for surgery and cancer patients going through chemo.

Shove off, PMS

A small study of 24 women with severe PMS found that massage reduced symp­toms such as pain, water retention, and mood swings. Try it with proven remedies such as exercise (and who-cares-if-they-work solutions like a little dark chocolate).

A 20-minute massage before cardiac catheterization lowers systolic blood pressure, according to a recent study.

“The Effects of Back Massage Before Diagnostic Cardiac Catheterization” was conducted by Mary Ellen McNamara, R.N., Diann C. Burnham, R.N., Christine Smith, R.N., and Diane L. Carroll, R.N., Ph.D.

Forty-six subjects with an average age of 64.9 years, most of whom were male, were randomly assigned to receive either a 20-minute back massage or 20 minutes of standard care prior to cardiac catheterization.

“Admission to the hospital for a diagnostic cardiac catheterization can be perceived as a threat to one’s health,” state the study’s authors. “The autonomic nervous system arousal, particularly in the sympathetic division, can elicit negative physiological and psychological human responses.”

The goal of this study was to determine the effects of a 20-minute back massage on the physiological and psychological responses of the cardiac patients.
Outcome measures were heart rate, heart-rate variability, blood pressure, respiration, peripheral skin temperature, pain perception and psychological state.

Pain perception and psychological state were evaluated by self-report. Subjects used the Profile of Mood States to rate their psychological states, and they rated pain on a visual analog scale, with “no pain” at one end of a line and “pain as bad as ever been experienced” at the other end.

Measurements were taken before the 20-minute intervention, immediately afterward and 10 minutes later.

Results of the study showed that subjects in the back-massage group had significantly lower systolic blood pressure immediately after the massage and 10 minutes later. No difference was found for the other outcomes.

“With a clear indication that back massage is beneficial, healthcare providers need to be taught the techniques of back massage,” state the study’s authors. “Massage therapists and other qualified providers of massage need to be able to articulate these study results in an effort to gain reimbursement for this human touch intervention.”

- Source: Knight Center for Cardiovascular Therapy, Massachusetts General Hospital, Boston, Massachusetts. Authors: Mary Ellen McNamara, R.N., Diann C. Burnham, R.N., Christine Smith, R.N., and Diane L. Carroll, R.N., Ph.D. Originally published in Alternative Therapies in Health and Medicine, January/February 2003, Vol. 9, No. 1, pp. 50-57.