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SHORT COMMUNICATION
Year : 2016  |  Volume : 5  |  Issue : 1  |  Page : 53-56

Immediate effect of ice bag application to head and spine on cardiovascular changes in healthy volunteers


Department of Naturopathy, SDM College of Naturopathy and Yogic Sciences, Ujire, Karnataka, India

Date of Web Publication13-Jan-2016

Correspondence Address:
A Mooventhan
SDM College of Naturopathy and Yogic Sciences, Ujire, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.173880

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  Abstract 

Background/Objectives: Ice application is one of the treatment procedures used in hydrotherapy. Though its various physiological/therapeutic effects were reported, ice bag application (IBA) to head and spine on cardiovascular changes were not reported. Hence, this study aims at evaluating the immediate effect of IBA to head and spine on cardiovascular changes in healthy volunteers. Materials and Methods: Twenty-eight subjects were randomized into three sessions ([i] IBA [ii] tap water bag application [TWBA] and [iii] control) and intervention was given in one of the 3-different orders. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate (PR) was assessed before and after 20-min of each intervention. Pulse pressure, mean pressure (MP), rate pressure product (RPP), and double product (Do-P) were derived by standard formula. Statistical analysis was performed by repeated measures of analysis of variance and post-hoc analysis with Bonferroni adjustment for multiple comparisons with the use of Statistical Package for Social Sciences version-16. Results: The results showed no significant difference between sessions in all variables. Within-group analysis showed significant reductions in SBP, PR, RPP, Do-P in IBA and TWBA sessions; Significant reduction in DBP, MP in IBA unlike TWBA; and no significant changes in all the variables of control session. Conclusions: Result of our study suggest that though both IBA and TWBA to head and spine might be considered as having effect on improving cardiovascular function in healthy volunteers, IBA to head and spine could be considered as a better choice than TWBA.

Keywords: Cardiovascular changes, head and spine, ice bag application, tap water bag application


How to cite this article:
Mooventhan A. Immediate effect of ice bag application to head and spine on cardiovascular changes in healthy volunteers. Int J Health Allied Sci 2016;5:53-6

How to cite this URL:
Mooventhan A. Immediate effect of ice bag application to head and spine on cardiovascular changes in healthy volunteers. Int J Health Allied Sci [serial online] 2016 [cited 2019 Sep 16];5:53-6. Available from: http://www.ijhas.in/text.asp?2016/5/1/53/173880


  Introduction Top


Hydrotherapy is the external/internal use of water in any of its forms (ice/water/steam) with various temperatures, pressure, duration, and site for health promotion or treatment of various diseases. It is used widely in ancient cultures including India, Egypt, China, etc.[1]

Application of ice for therapeutic purpose was used for its cooling effects that lead to various physiologic changes.[2] Various studies described ice as an agent that effectively reduce pain, swelling, edema, nerve conduction velocities, cellular metabolism, and local blood flow; induce local anesthesia around treatment area;[3],[4],[5] attenuating ischemic tissue damage; reducing microcirculatory impairment; muscle necrosis etc.[5]

Ice bag application (IBA) to head and spine is one of the hydrotherapic treatments used to reduce blood pressure (BP) but the precise physiological responses are inadequate. To the best of our knowledge, there is no known study reported the effect of IBA to head and spine on cardiovascular changes. Hence, this study aims at evaluating the effects of IBA to head and spine on cardiovascular changes in healthy volunteers.


  Materials and Methods Top


Subjects

Twenty-eight healthy male volunteers with the mean age of 20.57 ± 2.01 years; height 168.61 ± 6.53 cm; weight 61.58 ± 8.26 kg and body mass index 21.59 ± 1.94 kg/m 2 were recruited from a residential college based on the following criteria. Inclusion criteria: Age: 18-year and above, gender: Male, subject with no known disease conditions or regular use of relevant medications. Exclusion criteria: Subject with the habits of regular smoking and alcohol consumption; subjects with the history of mental illness, subject who is not willing to participate in the study. Study protocol was approved by the Institutional Ethics Committee and a written informed consent was obtained from each subjects.

Study design

A single group repeated measures design was used, under which each participant was assessed in three-different sessions ([i] IBA [ii] tap water bag application [TWBA] and [iii] control) at the same time of the three-different days. Subjects were randomly allocated to the three possible sessions using papers with the number “1, 2, and 3” were put in an envelope. The paper which drew out determined their order of sessions.[6] The order of the sessions were first (n = 10): IBA, TWBA, control; second (n = 9): TWBA, control, IBA; and third (n = 9): Control, IBA, TWBA on day-1, day-2, and day-3, respectively for each order. Assessments of systolic BP (SBP), diastolic BP (DBP), and pulse rate (PR) were performed before and after intervention. [Figure 1] will show the illustration of methods of study.
Figure 1: Illustration of methods of study. IBA: Ice bag application; TWBA: Tab water bag application

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Assessments

Assessment of SBP, DBP, and PR were measured before and after all three-intervention sessions using noninvasive arm type automatic BP monitor (MJ701f, Rossmax International Ltd., Taiwan). Minimum of two-measurements with the rest period of 1-min between the measurements were taken and averaged to get a final value.[7] In case of difference between the two-measurements by >10-mmHg, a three-measurement was taken after 1-min of rest period followed by the second measurement [8] and the average of the two-measurements which did not differ >10-mmHg was averaged to get a final value.

Assessments such as pulse pressure (PP), mean pressure (MP), rate pressure product (RPP), and double product (Do-P) were derived by using following formulas. PP was calculated as (SP − DP); MP as (DP + ⅓PP); RPP as (heart rate [HR] × SP/100); and Do-P as (HR × MP/100).[9]

Intervention

Each subject received three-intervention sessions in any one of the three-different orders [Figure 1]. Duration of each session was about 20-min.[3],[10]

Ice bag application

Subjects were asked to lie down in prone posture on the massage table. Then IBA was given to head and spine for 20-min [3],[10] by continuous longitudinal displacements [4] by means of rubber bag filled with ice [11] (1–2°C). The use of ice bag was mainly to avoid overuse injuries.[2]

Tap water bag application

It was given by means of rubber bag filled with tap water (24–25°C) as like as the IBA.

Control session

Subjects did not receive any hydrotherapic intervention, but they were asked to lie down on a massage table in prone posture for 20-min as like as in IBA and TWBA sessions.

Statistical analysis

Statistical analysis was performed with the use of Statistical Package for the Social Sciences (SPSS) for Windows, Version 16.0. Chicago, SPSS Inc. Repeated measures of analysis of variance and post-hoc analysis with Bonferroni adjustment for multiple comparisons were performed for within and between sessions. P < 0.05 was considered as significant.


  Results Top


Of 50-subjects assessed for eligibility, 22-subjects did not fulfill the criteria and did not include in the study. The reason for the elimination was given in [Figure 1]. There were no significant differences between sessions at baseline assessment [Table 1].
Table 1: Baseline and posttest assessment of ice bag, tap water bag and control sessions

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The results of our study showed no significant difference between sessions in all the variables but, within session analysis showed a significant reduction in SBP, PR, RPP, and Do-P with no significant changes in PP in both IBA and TWBA sessions. Reduction in DBP and MP were significant only in IBA, unlike TWBA. Whereas, in control session, no significant changes were observed in all the variables [Table 1].


  Discussion Top


The results of our study showed no significant difference between sessions in all the variables. It indicates that in influencing BP, IBA to head and spine might not be superior to TWBA or the control session in healthy volunteers.

Within-session analysis showed significant reductions in SBP, PR, RPP, and Do-P in both IBA and TWBA sessions but, better reductions were observed in IBA session than TWBA. Reduction in SBP might attribute to the effects on baroreceptor reflex or reduction of HR/PR because SBP = cardiac output (CO) × peripheral resistance, wherein CO = HR × stroke volume and thus HR forms one of the determinants of SBP, hence the reduction of HR in this study might reduce the SBP by decreasing CO.[12] Reduction in RPP and Do-P might attribute to the reduction in PR and BP. RPP and Do-P are the important indirect indicators of myocardial oxygen consumption and load on the heart. Reduction of these variables in this study indicates a strain lowering effects on the heart. When HR variability (HRV) analysis is not available, the RPP can be a simple measure of overall HRV. Hence, the reduction in RPP in our study might indicates better autonomic regulation of the heart.[9]

Significant reduction in DBP and MP in IBA session unlike in TWBA session might attribute to the reduction in centrally mediated peripheral resistance or vasodilatation through local mechanisms like nitric oxide etc.[12] In a previous study on cardiovascular and autonomic adjustments by three types of cold stimulation tasks such as (i) immersing the hand/foot in ice-water, (ii) IBA to forehead and (iii) IBA to face, showed increased HR and BP in hand immersion and insignificant reduction in HR with insignificant changes in BP in IBA to forehead and face. It indicates the application of ice other than hand such as forehead and face could have some effect on reducing HR and BP.[13] Similarly, IBA to head and spine in showed reduction in HR and BP which was significant in our study.

In control session, none of the variable showed significant changes. It indicates that lying down in prone posture on a table does not have a significant impact on reducing SBP, DBP, PR, PP, MP, RPP, and Do-P.

Strengths of the study

This is the first single group repeated measures study evaluating the effect of IBA and TWBA to head and spine on cardiovascular changes in healthy volunteers;male volunteers alone were recruited to avoid gender difference. According to a previous study recommendation, subjects with very high/low adipose tissue levels were excluded, because the effect of ice might depended on the amount of subcutaneous fat between the ice bag and the muscle.[10] Assessment of BP and PR was performed at the same times of the different days in order to reduce the diurnal variation. None of the subjects reported any side effects such as the cold induced burn/discomfort. Simple, low cost intervention and that can be given by anyone.

Limitations of the study

Study was conducted in healthy male volunteers which might limits the scope of this study to female and/or hypertensive subjects. Investigator was not blind to the intervention but, all measurements such as SBP, DBP, and PR were measured with the use of automatic BP monitor and assessment of PP, MP, RPP, and Do-P was performed by using standard formulas. Measurements such as HRV, peripheral arterial resistance and galvanic skin resistance would have given better understanding. Present study assessed only the immediate effects but did not assess how long the particular effect was persisting and its long-term effect on underling mechanisms. Hence, further studies are required (randomized control trials) in a large sample size with longer duration and advanced techniques to evaluate its effect on underlying mechanism.


  Conclusions Top


The result of this study suggest that although both IBA and TWBA to head and spine might be considered as having the effect on improving cardiovascular function in healthy volunteers, IBA to head and spine might be considered as a better choice than TWBA to head and spine because of its DBP, MP lowering effect unlike TWBA.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Mooventhan A, Nivethitha L. Scientific evidence-based effects of hydrotherapy on various systems of the body. N Am J Med Sci 2014;6:199-209.  Back to cited text no. 1
    
2.
Bender AL, Kramer EE, Brucker JB, Demchak TJ, Cordova ML, Stone MB. Local ice-bag application and triceps surae muscle temperature during treadmill walking. J Athl Train 2005;40:271-5.  Back to cited text no. 2
    
3.
Dykstra JH, Hill HM, Miller MG, Cheatham CC, Michael TJ, Baker RJ. Comparisons of cubed ice, crushed ice, and wetted ice on intramuscular and surface temperature changes. J Athl Train 2009;44:136-41.  Back to cited text no. 3
    
4.
Herrera E, Sandoval MC, Camargo DM, Salvini TF. Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Phys Ther 2010;90:581-91.  Back to cited text no. 4
    
5.
Holwerda SW, Trowbridge CA, Womochel KS, Keller DM. Effects of cold modality application with static and intermittent pneumatic compression on tissue temperature and systemic cardiovascular responses. Sports Health 2013;5:27-33.  Back to cited text no. 5
    
6.
Mooventhan A, Khode V. Effect of bhramari pranayama and OM chanting on pulmonary function in healthy individuals: A prospective randomized control trial. Int J Yoga 2014;7:104-10.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.
Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense HW, Joffres M, et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003;289:2363-9.  Back to cited text no. 7
    
8.
Mahmood SE, Prakash D, Srivastava JP, Zaidi ZH, Bhardwaj P. Prevalence of hypertension amongst adult patients attending out patient department of urban health training centre, department of community medicine, era's Lucknow medical college and hospital, Lucknow. J Clin Diagn Res 2013;7:652-6.  Back to cited text no. 8
    
9.
Bhavanani AB, Madanmohan, Sanjay Z. Immediate effect of chandra nadi pranayama (left unilateral forced nostril breathing) on cardiovascular parameters in hypertensive patients. Int J Yoga 2012;5:108-11.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
10.
Richendollar ML, Darby LA, Brown TM. Ice bag application, active warm-up, and 3 measures of maximal functional performance. J Athl Train 2006;41:364-70.  Back to cited text no. 10
    
11.
Kellogg JH. Rational Hydrotherapy. 2nd ed. Pune: National Institute of Naturopathy; 2005.  Back to cited text no. 11
    
12.
Muralikrishnan K, Balakrishnan B, Balasubramanian K, Visnegarawla F. Measurement of the effect of Isha Yoga on cardiac autonomic nervous system using short-term heart rate variability. J Ayurveda Integr Med 2012;3:91-6.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
13.
Allen MT, Shelley KS, Boquet AJ Jr. A comparison of cardiovascular and autonomic adjustments to three types of cold stimulation tasks. Int J Psychophysiol 1992;13:59-69.  Back to cited text no. 13
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1]


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