A pilot study conducted among older cancer survivors living in nursing homes found that the use of both reflexology and Swedish massage resulted in significant declines in salivary cortisol and pain, along with significant improvements in mood.

The study, “Reflexology versus Swedish Massage to Reduce Physiologic Stress and Pain and Improve Mood in Nursing Home Residents with Cancer: A Pilot Trial,” involved 18 nursing home residents ranging in age from 85 to 98 years, with an average age of 90. All participants had been diagnosed in the last five years with a solid tumor in the lung, prostate, colorectal or breast region and completed cancer treatments.

For the study, subjects were randomly assigned to one of two intervention schedules. Both groups received one week of friendly visits, during which baseline assessments took place. Then, participants in one of the groups received four weekly sessions of Swedish massage, followed by a one-week washout period and four weekly sessions of reflexology. Subjects in the other group received four weekly sessions of reflexology, followed by a one-week washout period and four weekly sessions of Swedish massage.

The friendly visits, Swedish massage and reflexology all were conducted by the same person. Both the Swedish massage and reflexology were performed according to a specific protocol and took place in the subject’s private room at the nursing home.

The Swedish massage consisted of 20 minutes of whole-hand light stroking and light pressure to the plantar and dorsal surfaces, as well as all tissue spanning from the toes to the knees of each leg.

The reflexology sessions were based on the Ingram method and consisted of a combination of finger-pivot and thumb-walking techniques, applied to reflex points on the base of the foot and the toes. Ten minutes were spent on each foot, stimulating the sole, instep and lateral aspects of the foot a total of five times.

The primary outcome measure for this study was physiologic distress, evaluated by sampling each subject’s daily average salivary cortisol levels. Another outcome measure was mood, assessed with the Apparent Affect Rating Scale. Pain was measured using the Checklist of Nonverbal Pain Indicators, designed for use with nonverbal older adults with cognitive impairment.

On each weekly intervention day, this data was collected at four different times during the day: between 7 and 7:30 a.m., between 11 and 11:30 a.m., between 1 and 1:30 p.m., and between 4 and 4:30 p.m.

“These times were selected to maximize the opportunities to observe the subjects mood and to capture the diurnal variation in salivary cortisol, while avoiding interruption of the interventionist’s presence,” state the study’s authors.

Results of the research revealed that both Swedish massage and reflexology resulted in significant decreases in salivary cortisol and pain, along with significant improvements in mood.

“The results suggest that both Swedish massage and reflexology were well-tolerated and potentially beneficial in reducing stress and pain and improving mood in older cancer survivors residing in nursing homes,” state the study’s authors. “Reflexology appeared to offer a slight benefit on outcomes when compared to Swedish massage, although this benefit was not significant.”


Authors: Nancy A. Hodgson and Doreen Lafferty.

Sources: Department of Acute and Chronic Care, School of Nursing, John Hopkins University, Baltimore, Maryland; and Genesis Rehabilitation Services, Kennet Square, Pennsylvania. Originally published in 2012 in Evidence-Based Complementary and Alternative Medicine.